Combinations of serotonin receptor agonists for treatment of movement disorders

ABSTRACT

The present invention relates to the use of 5-HT1 agonists in pharmaceutical compositions, compounds and methods for treatment of movement disorders related to neurological dysfunctions. The invention is particularly relevant for treatment of patients suffering from tardive dyskinesia, Parkinson&#39;s disease and associated disorders thereof. Kits of parts comprising the 5-HT1 agonist compounds or pharmaceutical compositions according to the present invention, as well as methods of preparation are also provided by the present invention.

REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/879,128, which is the U.S. national stage of PCT/DK2011/050383, filedOct. 13, 2011, which claims priority of U.S. Provisional ApplicationNos. 61/393,545, filed Oct. 15, 2010 and 61/491,945 filed Jun. 1, 2011,and Danish Patent Application No. PA201070441, filed Oct. 15, 2010. Theentire content of each application is incorporated herein by reference.

FIELD OF THE INVENTION

The present invention relates to use of 5-HT1 agonists as compounds, inpharmaceutical compositions, and in methods for treatment of movementdisorders related to neurological dysfunctions. The invention relates inparticular to treatment of patients suffering from movement disordersrelated to impaired dopamine levels in the neuronal synapse, such astardive dyskinesia, Parkinson's disease and associated disordersthereof. Kits of parts comprising the compounds or pharmaceuticalcompositions according to the present invention, as well as methods ofpreparation are also provided by the invention.

BACKGROUND OF THE INVENTION

Movement disorders are a group of diseases that affect the ability toproduce and control body movement, and are often associated withneurological disorders or conditions associated with neurologicaldysfunction. Movement disorders may manifest themselves in abnormalfluency or speed of movement, excessive or involuntary movement, orslowed or absent voluntary movement. Akathisia for example, is amovement disorder characterized by unpleasant sensations of “inner”restlessness, mental unease, or dysphoria that results in inability of apatient to sit still or remain motionless. Patients typically haverestless movement, including rocking from foot to foot and walking onthe spot when standing, shuffling and tramping the legs, rocking backand forth, or swinging one leg on the other when sitting. In severecases, patients constantly pace up and down in an attempt to relieve thesense of unrest, since the restlessness is felt from wakeup in themorning to sleep at night. Some patients have described the feeling as asense of inner tension and torment or chemical torture.

Another example of a movement disorder is dyskinesia which characterizedby various involuntary movements, which can affect discrete body partsor can become generalized and severely disabling. Tardive dyskinesia isone example of dyskinesia which is characterized by repetitive,involuntary, purposeless movements, such as grimacing, tongueprotrusion, lip smacking, puckering and pursing of the lips, and rapideye blinking. Involuntary movements of the fingers may appear as thoughthe patient is playing an invisible guitar or piano.

Often, the neurological disorder or condition which causes the movementdisorder is associated with dysfunction of the basal ganglia. Thedysfunction may be idiopathic, induced by certain drugs or infections,or caused by genetic defects.

Parkinson's disease (PD) is an example of a neurological disorderassociated with dysfunction of the basal ganglia. PD results in movementdisorders and is characterized by muscle rigidity, tremor, posturalabnormalities, gait abnormalities, a slowing of physical movement(bradykinesia) and in extreme cases a loss of physical movement(akinesia). The disease is caused by progressive death and degenerationof dopamine (DA) neurons in substantia nigra pars compacta and adysfunctional regulation of dopamine neurotransmission. In order toreplace the lost dopamine, PD is currently treated with Levodopa(L-DOPA, a precursor of dopamine), with dopamine agonists or otheragents that act by increasing the concentration of dopamine in thesynaptic cleft. PD is a common disease and affects 1% of persons above60 years of age.

Unfortunately, the treatment of PD with L-DOPA often gives rise todyskinesia (diminished voluntary movements and presence of involuntarymovements) in advanced PD patients with impaired regulations of DAlevels. This specific type of dyskinesia is called L-DOPA InducedDyskinesia (LID) and is caused by excessive dopamine levels in thesynapses (Jenner: Nat Rev Neurosci. 2008; 9(9): 665-77; Del Sorbo andAlbanese: J Neurol. 2008; 255 Suppl 4: 32-41). About 50% of patientstreated with L-DOPA develop LID, which severely limits optimal treatmentand reduce quality of life.

Movement disorders induced by drug therapy can also be related totreatment of other neurological or psychiatric diseases. Examples ofthese are tardive dyskinesia and akathesia, which are commonly developedas a side effect of long term treatment with neuroleptics for instancein patients suffering from e.g. schizophrenia.

Tardive dyskinesia may persist after withdrawal of the drug for months,years or can even be permanent. The primary prevention of tardivedyskinesia is achieved by using the lowest effective dose of aneuroleptic for the shortest time. If tardive dyskinesia is diagnosed,the therapy with the causative drug is discontinued. Both of theseapproaches cause difficulties for the therapeutical use of neuroleptics.

Shortly after the introduction of antipsychotic drugs in the 1950's,akathisia was recognized as one of the most common and distressing earlyonset adverse effects. Estimates of the prevalence of akathisia inneuroleptic-treated people range between 20% and 75%, occurring morefrequently in the first three months of treatment. Akathisia is not onlyrelated to acute administration of a neuroleptic, but also to a rapiddosage increase. Unfortunately, akathisia may be difficult todistinguish from psychotic agitation or anxiety, especially if theperson describes a subjective experience of akathisia in terms of beingcontrolled by an outside force. Therefore, the dosage of the drug whichcauses the movement disorder may even be further increased aftersymptoms of akathisia.

Movement disorders are frequently caused by impaired regulation ofdopamine neurotransmission. Dopamine acts by binding to synapticdopamine receptors D1, D2, D4, and D5, and the binding is controlled byregulated release and re-uptake of dopamine. Impaired regulation ofdopamine release or up-take can result in excess dopamine in thesynapses, which lead to the development of movement disorders.

As mentioned above, PD is an example of a movement disorder associatedwith dysfunctional regulation of dopamine neurotransmission, which iscaused by progressive degeneration of dopamine neurons. Tardivedyskinesia is another example of a movement disorder associated withdysfunctional regulation of dopamine neurotransmission. Neuroleptics actprimarily on the dopamine system and are drugs which block D2 dopaminereceptors, to prevent conditions associated with increased dopaminelevels. Tardive dyskinesia has been suggested to result primarily fromneuroleptic-induced dopamine super sensitivity in the nigrostriatalpathway, with the D2 dopamine receptor being most affected. Olderneuroleptics, which have greater affinity for the D2 binding site, areassociated with higher risks for tardive dyskinesia.

Dopamine release and re-uptake is regulated by a number ofneurotransmitters, including serotonin (5-HT). Other neurotransmittersthat directly or indirectly regulate dopamine neurotransmission are theinhibitory neurotransmitter gamma aminobutyric acid (GABA) andexcitatory amino acid glutamate.

Serotonin acts by binding to different serotonergic receptors. Theseinclude the 5-HT1A, 5-HT1B, 5-HT1D, 5-HT1E, 5-HT1F, 5-HT2A, 5-HT2B,5-HT2C, 5-HT3, 5-HT4, 5-HT5, 5-HT6, and 5-HT7 for which both agonistsand antagonists have been found. The serotonin receptors 5-HT1A, 5-HT1B,5-HT1D, 5-HT1E, 5-HT1F are located both post-synaptically andpre-synaptically and on the cell body. Serotonin neurotransmission isregulated by these receptors and by re-uptake mechanisms (Filip et al.Pharmacol. Reports, 2009, 61, 761-777; Ohno, Central Nervous SystemAgents in Medicinal Chemistry, 2010, 10, 148-157).

Agonists and antagonists of some serotonergic receptors have beeninvestigated for treatment of some movement disorders. Several serotonin5-HT1A agonists have been shown to ameliorate extrapyramidal sideeffects (EPS) associated with treatment with neuroleptics and to improvecognition in patients suffering from schizophrenia. (Newman-Tancredi:Current Opinion in Investigational Drugs, 2010, 11(7):802-812).

Modulators of serotonin (5-HT) neurotransmission have been shown toameliorate or prevent LID. One example thereof is sarizotan, which is a5-HT1A agonist and a dopamine receptor antagonist (Grégoire et al:Parkinsonism Relat Disord. 2009; 15(6): 445-52). In a phase 2A study andin an open labeled study sarizotan reduced LID. However, in severallarge phase 2b studies no significant effects of sarizotan compared toplacebo could be shown. The lack of effect is suggested to be due tolack of efficacy of the drug, or worsening of the Parkinson symptomscaused by the dopamine receptor antagonistic effects of the compound.

The effects of buspirone on Parkinson's disease have been studied in asmall open study (Ludwig et al: Clin Neuropharmacol. 1986; 9(4):373-8).It was found that doses (10-60 mg/day), which are normally used to treatpatients suffering from anxiety, did not have any effects on Parkinson'sdisease or dyskinesia. At higher doses (100 mg/day) it was observed thatbuspirone reduced dyskinesia but with a significant worsening ofdisability ratings. This showed that high doses of buspirone couldworsen the akinesia associated with Parkinson's disease.

Methods to treat LID using other 5-HT1A agonists have also beensuggested in US 2007/0249621. It has further been shown in a case studythat perospirone, which is a 5-HT1A agonist, could reduce involuntarymovement of a patient suffering from Huntington's disease. (Roppongi etal: Prog Neuropsychopharmacol Biol Psychiatry. 2007; 31(1):308-10).

Recently it has been shown that a combination of a 5-HT1A and a 5-HT1Bagonist increased efficacy in reducing L-DOPA induced dyskinesia can beobtained in animal models (e.g. Muñoz et al: Brain. 2008; 131(Pt 12):3380-94; Muñoz et al: Experimental Neurology 219 (2009) 298-307). 5-HT1Bagonists have potential to reduce LID via several mechanisms. However,5-HT1B receptors are found in the heart and it has been proposed thatmodulators of these receptors can be involved in development of valvularheart disease and other cardiac disorders associated with the use ofmodulators of serotonin receptors and serotonin reuptake (Elangbam etal: J Histochem Cytochem 53:671-677, 2005).

The combined 5-1-HT1A and 5-HT1B agonist eltoprazine[1-(2,3-dihydro-benzo[1,4]dioxin-5-yl)piperazine has also recently beensuggested for treatment of LID (WO2009/156380). Eltoprazine is estimatedto be equipotent in terms of activation of 5-HT1A and 5-HT1B receptors,and in addition has 5-HT2C antagonistic effects. The long term effectsof the use of the compound for treatment are unknown.

However, 5-HT1A agonists given in high doses can lead to the developmentof serotonin syndrome or serotonin toxicity a form of poisoning. Thesyndrome or toxicity is caused by increased activation of the 5-HT1A and5-HT2A receptors. Serotonin syndrome, by definition, is a group ofsymptoms presenting as mental changes, autonomic nervous systemmalfunction, and neuromuscular complaints. Patients may present withconfusion, agitation, diarrhea, sweating, shivering, hypertension,fever, increased white blood cell count, incoordination, marked increasein reflexes, muscle jerks, tremor, extreme stiffness, seizures and evencoma. The severity of changes ranges from mild to fatal. Because of theseverity of serotonin syndrome, it is therefore important to maintain alow exposure of the 5-HT1A agonist.

SUMMARY OF THE INVENTION

The present invention relates to use of 5-HT1 agonists for the treatmentof movement disorders. The combined activation of different serotonergicreceptors can lead to a synergic effect which more effectivelyinfluences the dopamine levels in the synapse and lead to efficacioustreatment of the movement disorders described herein. Additionally,since the combination of different 5-HT1 agonists provided by thepresent invention may allow for a reduction in dosage of the 5-HT1Aagonist compared to known treatments, the present invention can preventor reduce the risk of the development of serotonin syndrome and adverseeffects of treatment with 5-HT1A agonists.

The pharmaceutical compositions of the present invention comprise acompound, wherein said compound is either an agonist of two or more ofthe serotonin receptors selected from the group of

5-HT1B,

5-HT1D, and

5-HT1F,

receptors, or a selective agonist of the 5-HT1D receptor, or a selectiveagonist of the 5-HT1F receptor, or a pharmaceutically acceptablederivative thereof, and optionally further comprises a 5-HT1A agonist ora pharmaceutically acceptable derivative thereof, for treatment,prevention or alleviation of movement disorders.

Pharmaceutical compositions according to the present invention cancomprise a combination of two or more compounds wherein at least one isa) an agonist of the 5-HT1A receptor, and at least one other compound b)which is selected from: an agonist of two or more of the group of5-HT1B, 5-HT1D and 5-HT1F receptors, or a selective 5-HT1D receptoragonist, or a selective 5-HT1F receptor agonist.

Thus, the present invention can relate to efficacious treatment ofmovement disorders by using drugs that are agonists of the serotonin5-HT1A receptor and drugs that are either agonists of several serotoninreceptors including 5-HT1B, 5-HT1D, and 5-HT1F receptors, or selective5-HT1D receptor agonists, or selective agonists of the 5-HT1F receptors.

According to the present invention, said compound can be a combinedagonist of the 5-HT1B receptor and 5-HT1D receptor, or a selectiveagonist of the 5-HT1F receptor, or a combined agonist of the 5-HT1Breceptor, the 5-HT1D receptor and the 5-HT1F receptor, or apharmaceutically acceptable derivative of all agonist mentioned herein.

In another embodiment of the present invention, the compound is acombined agonist of two or more of the 5-HT1B, the 5-HT1D and the 5-HT1Freceptors having higher affinity and/or receptor activation efficacy forthe 5-HT1D receptor than for the 5-HT1B receptor, or having higheraffinity and/or receptor activation efficacy for the 5-HT1D receptorthan for the 5-HT1B and 5-HT1F receptors.

In a preferred embodiment of the present invention, the pharmaceuticalcomposition comprises a compound selected from the group of sumatriptan,zolmitriptan, rizatriptan, naratriptan, almotriptan, frovatriptan andeletriptan or a derivative thereof.

In another embodiment of the present invention, the pharmaceuticalcomposition comprises a compound selected from the group of COL-144(LY573144), LY334370, LY344864, or a derivative thereof.

In one embodiment of the present invention, the pharmaceuticalcomposition comprises a 5-HT1A agonist selected from the group ofalnespirone, binospirone, buspirone, gepirone, ipsapirone, perospirone,tandospirone, befiradol, repinotan piclozotan, osemozotan, flesinoxan,flibanserin and sarizotan or a derivative thereof, wherein the 5-HT1Aagonists buspirone and tandospirone or derivatives thereof areparticularly preferred.

In one embodiment, the compound is a combined agonist of two or more ofthe 5-HT1B, the 5-HT1D and the 5-HT1F receptors, or a selective 5-HT1Dagonist, or a selective 5-HT1F agonist and is administered in doses of0.05-200 mg/day, preferably in the ranges of 0.5 to 60 mg/day and evenmore preferred in the range of 0.5 to 10 mg/day.

In a preferred embodiment of the present invention, the 5-HT1A agonistis administered in doses of 0.5 mg/day to 100 mg/day and the compound isa combined agonist of two or more of the 5-HT1B, the 5-HT1D and the5-HT1F receptors, or a selective 5-HT1D agonist, or a selective 5-HT1Fagonist and is administered in doses of 0.1 mg/day to 60 mg/day, evenmore preferably wherein 5-HT1A agonist is administered in doses of 0.5mg/day to 30 mg/day and the compound is a combined agonist of two ormore of the 5-HT1B, the 5-HT1D and the 5-HT1F receptors, or a selective5-HT1D agonist, or a selective 5-HT1F agonist and is administered indoses of 0.5 mg/day to 10 mg/day.

The pharmaceutical composition according to the present invention mayfurther comprise one or more second active ingredients.

Pharmaceutical compositions according to present invention may furthercomprise one or more agents selected from the group of agents increasingthe dopamine concentration in the synaptic cleft, dopamine, L-DOPA ordopamine receptor agonists or a derivative thereof.

The movement disorders according to the present invention are associatedwith altered synaptic dopamine levels, such as for example disordersselected from the group of akathisia, tardive dyskinesia and dyskinesiaassociated with Parkinson's disease, and in particular L-DOPA induceddyskinesia.

The pharmaceutical compositions according to the present invention maybe formulated for parenteral administration, or for enteraladministration such as oral administration. They may further beformulated for crossing the blood-brain barrier.

The present invention further provides compounds which are combined5-HT1B, 5-HT1D and/or a 5-HT1F agonist for treatment for treatment,prevention or alleviation of movement disorders.

Methods for treatment, prevention or alleviation of movement disorderscomprising one or more steps of administration of an effective amount ofa pharmaceutical composition or a compound as defined herein are alsoaspects of the present invention.

In a preferred embodiment, such methods may further comprise a step ofsimultaneous, sequential or separate administration of an effectiveamount of one or more second active ingredients, such as a 5-HT1Aagonist.

5-HT1A agonists used in methods of the present invention may be selectedfrom the group of alnespirone, binospirone, buspirone, gepirone,ipsapirone, perospirone, tandospirone, befiradol, repinotan, piclozotan,osemozotan, flesinoxan, flibanserin and sarizotan or a derivativethereof, wherein buspirone and tandospirone are preferred.

In one embodiment of a method for treatment of the present invention,the 5-HT1A agonist is administered in doses of 0.05 mg/day to 500mg/day, wherein the doses of 0.5 mg/day to 100 mg/day are preferred, andthe doses of 0.5 mg/day to 30 mg/day are even more preferred.

Methods according to the present invention may further comprise steps ofadministering one or more agents selected from the group of agentsincreasing the dopamine concentration in the synaptic cleft, dopamine,L-DOPA or dopamine receptor agonists or a derivative thereof.

The present invention further provides kits of parts comprising thepharmaceutical composition or compound as defined herein for treatment,prevention or alleviation of movement disorders by simultaneous,sequential or separate administration. Such kits may further compriseone or more second active ingredients, such as a 5-HT1A agonist forexample selected from the group of alnespirone, binospirone, buspirone,gepirone, ipsapirone, perospirone, tandospirone, befiradol, repinotanpiclozotan, osemozotan, flesinoxan, flibanserin and sarizotan or aderivative thereof (wherein buspirone and tandospirone or derivativesthereof are preferred), or an agent increasing the dopamineconcentration in the synaptic cleft, dopamine, L-DOPA, dopamine receptoragonists or a derivative thereof.

The present invention further provides methods for preparation of apharmaceutical composition as defined herein.

DEFINITIONS

An “autoreceptor” as referred to herein, is a receptor located on apre-synaptic nerve cell and serves as a part of a feedback loop insignal transduction. It is sensitive to those neurotransmitters orhormones that are released by the neuron in whose membrane theautoreceptor sits, and functions to downregulate the release ofneurotransmitters in the synapse.

The term “blood-brain barrier” refers to selective tight junctionsbetween endothelial cells in CNS capillaries that restrict the passageof solutes into the cerebrospinal fluid (CSF).

The term “agonist” in the present context refers to a substance capableof binding to and activating a receptor. A 5-HT1A receptor agonist(5-HT1A agonist) is thus capable of binding to and activating the 5-HT1Areceptor. A 5-HT1B receptor agonist (5-HT1B agonist) is capable ofbinding to and activating the 5-HT1B receptor. A 5-HT1D receptor agonist(5-HT1D agonist) is capable of binding to and activating the 5-HT1Dreceptor. A 5-HT1F receptor agonist (5-HT1F agonist) is capable ofbinding to and activating the 5-HT1F receptor. Said agonist compound maybe an agonist of several different types of receptors, and thus capableof binding and activating several different types of receptors. Saidagonist compound can also be a selective agonist which only binds andactivates one type of receptor.

The term “antagonist” in the present context refers to a substancecapable of inhibiting the effect of a receptor agonist.

The terms “dopamine,” “DA” and “4-(2-aminoethyl)benzene-1,2-diol,” referto a catecholamine neurotransmitter and hormone. Dopamine is a precursorof adrenaline (epinephrine) and noradrenaline (norepinephrine) andactivates the five types of dopamine receptors—D1, D2, D3, D4, andD5—and their variants.

A “heteroreceptor” as referred to herein, is a receptor regulating thesynthesis and/or the release of mediators other than its own ligand.Heteroreceptors are presynaptic receptors that respond toneurotransmitters, neuromodulators, or neurohormones released fromadjacent neurons or cells.

An “individual” in need as referred to herein, is an individual that maybenefit from the administration of a compound or pharmaceuticalcomposition according to the present invention. Such an individual maysuffer from a movement disorder or be in risk of suffering from amovement disorder. The individual may be any human being, male orfemale, infant, middle-aged or old. The movement disorder to be treatedor prevented in the individual may relate to the age of the individual,the general health of the individual, the medications used for treatingthe individual and whether or not the individual has a prior history ofsuffering from diseases or disorders that may have or have inducedmovement disorders in the individual.

“L-DOPA” or “3,4-dihydroxyphenylalanine” is a precursor to theneurotransmitters dopamine, norepinephrine (noradrenaline), andepinephrine (adrenaline). L-DOPA is able to cross the blood-brainbarrier, and is converted to dopamine by the enzyme aromatic L-aminoacid decarboxylase (AADC), also known as DOPA decarboxylase (DDC).L-DOPA is used for treatment of Parkinson's disease.

A “neurotransmitter” as referred to herein, is a substance, whichtransmits signals from a neuron to a target cell across a neuronalsynapse.

The terms “Parkinson's disease,” “Parkinson's” and “PD” refer to aneurological syndrome characterized by a dopamine deficiency, resultingfrom degenerative, vascular, or inflammatory changes in the basalganglia of the substantia nigra. This term also refers to a syndromewhich resembles Parkinson's disease, but which may or may not be causedby Parkinson's disease, such as Parkinsonian-like side effects caused bycertain antipsychotic drugs. Parkinson's disease is also referred to asparalysis agitans and shaking palsy.

“Partial agonists” in the present context are compounds able to bind andactivate a given receptor, but having only partial efficacy at thereceptor relative to a full agonist. Partial agonists can act asantagonists when competing with a full agonist for receptor occupancyand producing a net decrease in the receptor activation compared to theeffects or activation observed with the full agonist alone.

“Selective agonists” in the present context are compounds which areselective and therefore only binds and activates one type of receptor.Thus a selective 5-HT1D receptor agonist only is selective for the5-HT1D receptor, and a selective 5-HT1F receptor agonist is selectivefor the 5-HT1F receptor.

The term “synapse” refers to an area of a neuron that permits saidneuron to pass an electrical or chemical signal to another cell. In asynapse, a plasma membrane of the signal-passing neuron (thepre-synaptic neuron) comes into close apposition with the membrane ofthe target (post-synaptic) cell.

The term “pharmaceutically acceptable derivative” in present contextincludes pharmaceutically acceptable salts, which indicate a salt whichis not harmful to the patient. Such salts include pharmaceuticallyacceptable basic or acid addition salts as well as pharmaceuticallyacceptable metal salts, ammonium salts and alkylated ammonium salts. Apharmaceutically acceptable derivative further includes esters andprodrugs, or other precursors of a compound which may be biologicallymetabolized into the active compound, or crystal forms of a compound.

The terms “serotonin,” “5-hydroxytryptamine” and “5-HT” refers to aphenolic amine neurotransmitter produced from tryptophan byhydroxylation and decarboxylation in serotonergic neurons of the centralnervous system and enterochromaffin cells of the gastrointestinal tract.Serotonin is a precursor of melatonin.

The term “terminal” in the present context refers to a neuronalterminal.

The term “therapeutically effective amount” of a compound as used hereinrefers to an amount sufficient to cure, alleviate, prevent, reduce therisk of, or partially arrest the clinical manifestations of a givendisease or disorder and its complications. An amount adequate toaccomplish this is defined as a “therapeutically effective amount”.

The terms “treatment” and “treating” as used herein refer to themanagement and care of a patient for the purpose of combating acondition, disease or disorder. The term is intended to include the fullspectrum of treatments for a given condition from which the patient issuffering, such as administration of the active compound for the purposeof: alleviating or relieving symptoms or complications; delaying theprogression of the condition, disease or disorder; curing or eliminatingthe condition, disease or disorder; and/or preventing the condition,disease or disorder, wherein “preventing” or “prevention” is to beunderstood to refer to the management and care of a patient for thepurpose of hindering the development of the condition, disease ordisorder, and includes the administration of the active compounds toprevent or reduce the risk of the onset of symptoms or complications.The patient to be treated is preferably a mammal, in particular a humanbeing. Treatment of animals, such as mice, rats, dogs, cats, cows, sheepand pigs, is, however, also within the scope of the present invention.The patients to be treated according to the present invention can be ofvarious ages.

A “triptan” in the present context is a compound part of a family oftryptamine-based drugs used as abortive medication in the treatment ofmigraines and cluster headaches. The triptans are agonists of theserotonin 5-HT1B, 5-HT1D, 5-HT1E and/or 5-HT1F receptors, and may be ormay not be selective agonists of one or more of the serotonin 5-HT1B,5-HT1D, 5-HT1E and/or 5-HT1F receptors.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 shows the effect of combination of buspirone and zolmitriptan onL-DOPA induced abnormal involuntary movements (AIMs) in rats (TotalAIMs=sum of locomotive (LO) or axial (AX), limb (LI), and orolingual(OL) AIM scores). Asterics (**) denote effects of P <0.01 compared withvehicle calculated by use of the one-way ANOVA test and the Tukeypost-hoc test in each time point. Diamonds denote rats administeredvehicle only, filled square denote rats administered 1 mg/kg/daybuspirone, triangles denote rats administered 10 mg/kg/day zolmitriptan,filled circles denote rats administered 3 mg/kg/day zolmitriptan incombination with 1 mg/kg/day buspirone and open squares denote ratsadministered 10 mg/kg/day zolmitriptan in combination with 1 mg/kg/daybuspirone. The results demonstrate that a combined use of buspirone (a5-HT1A agonist) and zolmitriptan (a combined 5-HT1B/5-HT1D receptoragonist that has higher affinity and/or receptor activation efficacy of5-HT1D receptors compared to 5-HT1B receptors) has potency to reduce AIMsignificantly compared to the use of buspirone or zolmitriptan alone.

FIG. 2 shows the effect of zolmitriptan (3 mg/kg) and buspirone (1mg/kg) on coordination of Sprague-Dawley (SD) rats in rotarod test.Asterics (**) denote effects of P <0.01 when compared with vehicle,calculated by use of the one-way ANOVA test and the Tukey post-hoc test.The first column from the left denotes rats administered vehicle only,the middle column denotes rats administered pentobarbital, and the lastcolumn from the left denotes rats administered with a combination ofzolmitriptan (3 mg/kg) and buspirone (1 mg/kg). The results demonstratethat the combination of zolmitriptan (3 mg/kg) and buspirone (1 mg/kg)does not significantly induce sedation.

FIG. 3 shows the effect of zolmitriptan (3 mg/kg)+buspirone (1 mg/kg) ontotal move distance of naïve rats in open field test. Asterics (**)denote effects of P <0.01 when compared with vehicle, calculated by useof the one-way ANOVA test and the Tukey post-hoc test. The first columnfrom the left denotes rats administered vehicle only, the middle columndenotes rats administered pentobarbital, and the last column from theleft denotes rats administered with a combination of zolmitriptan (3mg/kg) and buspirone (1 mg/kg). The results demonstrate that thecombination of zolmitriptan (3 mg/kg) and buspirone (1 mg/kg) does notsignificantly induce sedation.

FIG. 4 shows the effect of combination of buspirone and zolmitriptan onL-DOPA induced abnormal involuntary movements (AIMS) in rats (TotalAIMs=sum of locomotive (LO) oraxial (AX), limb (LI), and orolingual (OL)AIM scores). Asterics (**) denote effects of P <0.01 compared withvehicle calculated by use of the one-way ANOVA test and the Tukeypost-hoc test in each time point. Zolmitriptan was given 35 minutesbefore L-DOPA while buspirone was given 30 minutes before L-DOPA.Diamonds denote rats administered vehicle only, filled square denoterats administered 0.5 mg/kg buspirone, triangles denote ratsadministered 3 mg/kg zolmitriptan in combination with 0.5 mg/kgbuspirone, filled circles denote rats administered 10 mg/kg zolmitriptanin combination with 0.5 mg/kg buspirone and open squares denote ratsadministered 10 mg/kg zolmitriptan in combination with 1 mg/kgbuspirone. The curves show different treatments: buspirone (0.5 mg/kg);buspirone (0.5 mg/kg)+zolmitriptan (3 mg/kg); buspirone (0.5mg/kg)+zolmitriptan (10 mg/kg) and buspirone (1 mg/kg)+zolmitriptan (10mg/kg).

DETAILED DESCRIPTION OF THE INVENTION

The present invention relates to the use of combinations of compoundsthat are able to modulate dopamine neurotransmission through activationsof serotonin receptors. More specifically the present invention relatesto combinations of compounds that act as agonists of the serotonin5-HT1A receptor and compounds that are agonists of several serotoninreceptors including 5-HT1B, 5-HT1D, and 5-HT1F receptors.

5-HT1 Receptors

Serotonin, or 5-Hydroxytryptamine (5-HT), is a neurotransmitter that hasimportant functions in the central nervous system of humans and animals.Serotonin has been found to regulate mood, appetite, sleep, musclecontraction, and some cognitive functions including memory and learning.Serotonin acts by binding to different serotonergic receptors, alsoknown as 5-HT receptors. These are a group of G protein-coupledreceptors (GPCRs) and ligand-gated ion channels (LGICs) found in thecentral and peripheral nervous systems. The 5-HT receptors include the5-HT1A, 5-HT1B, 5-HT1D, 5-HT1E, 5-HT1F, 5-HT2A, 5-HT2B, 5-HT2C, 5-HT3,5-HT4, 5-HT5, 5-HT6, and 5-HT7 receptors for which both agonists andantagonists have been found.

The 5-HT1 receptors is a subfamily of 5-HT receptors including the5-HT1A, 5-HT1B, 5-HT1D, 5-HT1E, and 5-HT1F receptors, which are Gprotein-coupled receptors (GPCRs) that mediate inhibitoryneurotransmission. These are located post-synaptically, pre-synapticallyand on the cell body of the neurons in the cerebral cortex, hippocampus,septum, amygdale, raphe nuclei, basal ganglia and thalamus. Due to theirinhibitory roles in neurotransmission, the 5-HT1 receptors play animportant role in regulation of dopamine release.

5-HT1A receptors are widely distributed in the CNS. They are principallylocated in the hippocampus, cingulated end enthorhinal cortices, lateralseptum and mesencephalic raphe nucleus. The 5-HT1A receptors areinvolved in motor behavior, copulatory behavior, pain perception,emotional behavior, and cognitive processes. The 5-HT1A receptors areautoreceptors in the raphe nuclei where they are located on the cellbodies or dendrites of 5-HT neurons, or they are post-synapticreceptors. In general, activation of 5-HT1A receptors reduces therelease of neurotransmitters such as 5-HT and the excitatory amino acidglutamate, which further leads to changes in dopamine release.

The 5-HT1B receptor is highly expressed in the basal ganglia and thefrontal cortex. They function as autoreceptors on the terminals of 5-HTneurons inhibiting 5-HT release, or as terminal heteroreceptors ongamma-amino butyric acid (GABA), acetylcholine (Ach) and glutamateneurons where they control the release of these neurotransmitters.

The 5-HT1D receptor is present both pre-synaptically andpost-synaptically in the CNS and in the periphery. The highestexpression of 5-HT1D receptors in the rat brain has been found in thebasal ganglia (particularly in the substantia nigra, globus pallidus andcaudate putamen), the hippocampus and the cortex, while in the humanbrain in the basal ganglia (the substantia nigra, globus pallidus), themidbrain (the periaqueductal grey) and the spinal cord. 5-HT1D receptorsare either autoreceptors on the terminals of 5-HT neurons (they inhibit5-HT release) or terminal heteroreceptors on gamma amino butyric acid(GABA), acetylcholine (Ach) and glutamate neurons (they control therelease of these neurotransmitters). 5-HT1D receptors have beendescribed as being involved in pain perceptions and 5-HT1D agonists havebeen developed as treatment of migraine.

The 5-HT1F receptor has been found in several CNS areas (the dorsalraphe nucleus, hippocampus, cingulate and entorhinal cortices,claustrum, caudate nucleus, brainstem) and—based onlocalization—suggested to function as an autoreceptor. The triptans showhigh affinity for the 5-HT1F receptors.

The basal ganglia are a group of nuclei in the brain which are connectedto cerebral cortex, thalamus and other brain areas. The basal gangliaare associated with a variety of functions, including motor control. Thestriatum is the largest part of the basal ganglia, and receives inputfrom many part of the brain, but sends output only to other parts of thebasal ganglia. The pallidum receives the most important input from thestriatum, and sends inhibitory output to a number of motor-related areasof the cortex. The substantia nigra is an important part of the basalganglia and is divided into to parts. The substantia nigra parsreticulate receives input from other areas of the brain, while thesubstantia nigra pars compacta provides dopamine into the striatum.Thus, the substantia nigra pars compacta plays an important role indopamine neurotransmission and its most prominent function is motorcontrol.

The 5-HT1 receptors are particularly important in the regulation of PDand associated movement disorders. In progressed PD there is extensivedegenerative loss of DA neurons in substantia nigra. Transformation ofL-DOPA to dopamine takes place in the remaining dopamine neurons and in5-HT (serotonin) neurons, which have been shown to be able to metabolizeL-DOPA to dopamine and store and release dopamine. However, serotoninneurons lack a pre-synaptic feedback control mechanism for the releaseof dopamine, such as the dopamine transporter and D2 auto-receptor andare therefore unable to regulate release of dopamine in a normal way.This leads to impaired levels of DA in the synapse and to movementdisorders

5-HT1 Agonists

The present invention relates to a combination of 5-HT1 agonist fortreatment of movement disorders, for example such as movement disordersassociated with altered or impaired DA regulation.

The combined effects of an 5-HT1A agonist and either a) an agonist oftwo or more of the 5-HT1B, 5-HT1D, and 5-HT1F receptors or b) aselective 5-HT1D receptor agonist, or c) a selective agonist of a 5-HT1Freceptor lead to an effective suppression of the excessive DAneurotransmission, that ameliorates or treats movement disorders such asfor example LID.

The present invention relates to compounds which are either a) agonistsof two or more of the group of serotonin

5-HT1B,

5-HT1D,

5-HT1F

receptors (a combined agonist), or b) a selective 5-HT1D agonist, or c)selective agonists of the 5-HT1F receptor, or pharmaceuticallyacceptable derivative thereof. Such agonists may be compounds bindingand activating the 5-HT1B receptor and the 5-HT1D receptor, thuscombined 5-HT1B receptor and 5-HT1D receptor agonists. Such agonists mayfurther be compounds binding and activating the 5-HT1F receptor, thusagonists of the 5-HT1F receptor, or the agonists may further becompounds binding and activating the 5-HT1D receptor, such as selective5-HT1D receptor agonists. Such agonists may additionally be compoundsbinding and activating the 5-HT1B receptor, 5-HT1D receptor and the5-HT1F receptor, thus a combined agonist of the 5-HT1B, 5-HIT1D and5-HT1F receptors. Pharmaceutically acceptable derivatives of combined5-HT1B and 5-HT1D agonists, and/or 5-HT1F agonist are also part of thepresent invention.

In one embodiment, of the present invention, the 5-HT1 agonist of thepresent invention is a compound which is a combined agonist of the twoor more of the serotonin receptors

5-HT1A,

5-HT1B,

5-HT1D

5-HT1F

Such an agonists may be compounds binding and activating the 5-HT1Areceptor and the 5-HT1B receptor, or compounds binding and activatingthe 5-HT1A receptor and the 5-HT1D receptor, or compounds binding andactivating the 5-HT1A receptor and the 5-HT1F receptor, or compoundsbinding and activating the 5-HT1A receptor and the 5-HT1B receptor andthe 5-HT1D receptor, or compounds binding and activating the 5-HT1Areceptor and the 5-HT1B receptor and the 5-HT1F receptor, or compoundsbinding and activating the 5-HT1A receptor and the 5-HT1D receptor andthe 5-HT1F receptor, or compounds binding and activating the 5-HT1A,5-HT1B, 5-HT1D and the 5-HT1F receptors.

Certain mixed 5-HT1B/5-HT1D receptor agonists have been developed, and asubgroup of 5-HT1B/5-HT1D receptor agonists are collectively called “thetriptans”. The triptans have been developed as medication for treatmentof migraine and have been used for therapy for more than a decade. Thesecompounds include sumatriptan, zolmitriptan, rizatripan, naratripan,almotriptan, frovatriptan and eletriptan. In addition to their effectson 5-HT1B and 5-HT1D receptors, some “triptans” bind to and activate5-HT1F receptors and other 5-HT receptors.

The combined agonist of two or more of the 5-HT1B, 5-HT1D and 5-HT1Freceptors according to the present invention may be selected from thegroup of sumatriptan(1-[3-(2-dimethylaminoethyl)-1H-indol-5-yl]-N-methyl-methanesulfonamide),zolmitriptan((S)-4-([3-[2-(dimethylamino)ethyl]-1H-indol-5-yl]methyl)-1,3-oxazolidin-2-one),rizatripan(N,N-dimethyl-2-[5-(1H-1,2,4-triazol-1-ylmethyl)-1H-indol-3-yl]ethanamine),naratripan(N-methyl-2-[3-(1-methylpiperidin-4-yl)-1H-indol-5-yl]ethanesulfonamide),almotriptan(N,N-dimethyl-2-[5-(pyrrolidin-1-ylsulfonylmethyl)-1H-indol-3-yl]-ethanamine),frovatriptan((+)-(R)-3-methylamino-6-carboxamido-1,2,3,4-tetrahydrocarbazole) andeletriptan((R)-3-[(-1-methylpyrrolidin-2-yl)methyl]-5-(2-phenylsulfonylethyl)-1H-indole)or a pharmaceutically acceptable derivative thereof.

In a preferred embodiment the combined agonist of two or more of the5-HT1B, 5-HT1D and 5-HT1F receptors are selected from rizatriptan,naratriptan, zolmitriptan and frovatriptan or a pharmaceuticallyacceptable derivative thereof.

In a preferred embodiment of the present invention, the combined agonistof two or more of the 5-HT1B, 5-HT1D and 5-HT1F receptors are selectedfrom zolmitriptan and frovatriptan or a pharmaceutically acceptablederivative thereof.

Compounds according to the present invention which are capable ofbinding and activating several 5-HT receptors, can have differentaffinities and/or different receptor activation efficacy for different5-HT1 receptors, wherein affinity refers to the number and size ofintermolecular forces between a ligand and its receptor, and residencetime of a ligand at its receptor binding site, and receptor activationefficacy refers to the ability of the compound to produce a biologicalresponse upon binding to the target receptor and the quantitativemagnitude of this response. Such differences in affinity and receptoractivation efficacy can be determined by receptor binding/activationstudies which are conventional in the art, for instance by generatingEC₅₀ and Emax values for stimulation of [³⁵S]-GTPγS binding in cellsexpressing one or several types of 5-HT1 receptors as mentioned herein,or on tissues expressing the different types of 5-HT receptors. Highaffinity means that a lower concentration of a compound is needed toobtain a binding of 50% of the receptors compared to compounds whichhave lower affinity; high receptor activation efficacy means that alower concentration of the compound is needed to obtain a 50% receptoractivation response (low EC₅₀ value), compared to compounds which havelower affinity and/or receptor activity efficacy (higher EC₅₀ value).

The property of differing affinity and/or receptor activation efficacyfor 5-HT1 receptors can be used for treatment, since the responses ofdifferent receptors are modified when the administered doses of thecompound are varied. In one embodiment of the present invention, thecompounds which are combined agonists of the present invention havediffering affinities and/or receptor activation efficacies for two ormore of the receptors selected from 5-HT1B, 5-HT1D and 5-HT1F serotoninreceptors. In another embodiment the compounds which are combinedagonists of the present invention have different affinities and/orreceptor activation efficacies for two or more of the receptors selectedfrom 5-HT1A, 5-HT1B, 5-HT1D and 5-HT1F serotonin receptors. Thus, in oneembodiment of the present invention, a compound which is a combinedagonist of the 5-HT1B, 5-HT1D and 5-HT1F receptors has higher affinityand/or receptor activation efficacy for the 5-HT1B receptor compared tothe 5-HT1D and 5-HT1F receptors, or a compound which is a combinedagonist of the 5-HT1B, 5-HT1D and 5-HT1F receptors has higher affinityand/or receptor activation efficacy for the 5-HT1D receptor compared tothe 5-HT1B and 5-HT1F receptors, or a compound which is a combinedagonist of the 5-HT1B, 5-HT1D and 5-HT1F receptors has higher affinityand/or receptor activation efficacy for the 5-HT1F receptor compared tothe 5-HT1B and 5-HT1D receptors.

In one embodiment of the present invention, the compound which is acombined agonist of the 5-HT1B, 5-HT1D and 5-HT1F receptor has an EC₅₀value for the 5-HT1D receptor which is less than the EC₅₀ value for the5-HT1B receptor, such as in the range of 0-99% of the EC₅₀ value for the5-HT1B receptor, for example less than 99% such as less than 85%, suchas less than 70% such as less than 60%, such as less than 50%, such asless than 40%, such as less than 30%, such as less than 20% such as lessthan 1%, such as less than 0.01% of the EC₅₀ value for the 5-HT1Breceptor or less.

The receptor activation potency of compounds which are 5-HT1 receptoragonists of the present invention can also be measured in p(A₅₀) valueswhich is a conventional method for determining the receptor activationefficacy of an agonist. In another embodiment of the present invention,the compound which is a combined agonist of the 5-HT1B, 5-HT1D and/orthe 5-HT1F receptor compounds can have difference in p(A₅₀) value forthe different receptors. For instance such a difference can be in therange of 1 to 5, such as 1 to 2, or such as 2 to 3 or such as 3 to 4, orsuch as 4 to 5 or more.

In a preferred embodiment of the present invention, the differencebetween the p(A₅₀) of the 5-HT1D receptor and the p(A₅₀) of the 5-HT1Bis in the range of 1 to 5.

Compounds which have higher receptor activation efficacy for the 5-HT1 Dreceptor than for the 5-HT1B receptor or the 5-HT1F receptors arepreferred according to the present invention. Thus in a preferredembodiment of the present invention, the compound is zolmitriptan,eletriptan and rizatripan or a pharmaceutically acceptable derivativethereof.

Pharmaceutical compositions as defined herein can comprise a selective5-HT1D receptor agonist or a pharmaceutically acceptable derivativethereof and may optionally further comprise a 5-HT1A receptor agonist.

In one embodiment of the present invention, the 5-HT1F receptors agonistis selected from the group of COL-144 (lasmiditan), LY573144:2,4,6-trifluoro-N-[6-[(1-methylpiperidin-4-yl)carbonyl]pyridin-2yl]benzamide)),LY334370(4-fluoro-N-[3-(1-methylpiperidin-4-yl)-1H-indol-5-yl]benzamide) andLY344864(N-(6-dimethylamino-6,7,8,9-tetrahydro-5H-carbazol-3-yl)-4-fluorobenzamide)or a pharmaceutically acceptable derivative thereof.

The present invention further relates to agonists of the serotonin5-HT1A receptor (5-HT1A agonists). Such 5-HT1A agonists may be partialor may not be partial agonists of the 5-HT1A receptor. The 5-HT1Aagonists may be selected from the group consisting of alnespirone((+)-4-dihydro-2H-chromen-3-yl]-propylamino]butyl]-8-azaspiro[4.5]decane-7,9-dione),binospirone(8-[2-(2,3-dihydro-1,4-benzodioxin-2-ylmethylamino)ethyl]-8-azaspiro[4.5]decane-7,9-dione),buspirone(8-[4-(4-pyrimidin-2-ylpiperazin-1-yl)butyl]-8-azaspiro[4.5]decane-7,9-dione),gepirone(4,4-dimethyl-1-[4-(4-pyrimidin-2-ylpiperazin-1-yl)butyl]piperidine-2,6-dione),ipsapirone(9,9-dioxo-8-[4-(4-pyrimidin-2-ylpiperazin-1-yl)butyl]-9λ6-thia-8-azabicyclo[4.3.0]nona-1,3,5-trien-7-one),perospirone (3aR,7aS)-2-{4-[4-(1,2-benzisothiazol-3-yl)piperazin-1-yl]butyl}hexahydro-1H-isoindole-1,3(2H)-dione,tandospirone((1R,2R,6S,7S)-4-{4-[4-(pyrimidin-2-yl)piperazin-1-yl]butyl}-4-azatricyclo[5.2.1.02,6]decane-3,5-dione),befiradol (F-13,640)(3-chloro-4-fluorophenyl-[4-fluoro-4-([(5-methylpyridin-2-yl)methylamino]-methyl)piperidin-1-yl]methanone,repinotan((R)-(−)-2-[4-[(chroman-2-ylmethyl)-amino]-butyl]-1,1-dioxo-benzo[d]isothiazolone),piclozotan(3-chloro-4-[4-[4-(2-pyridinyl)-1,2,3,6-tetrahydropyridin-1-yl]butyl]-1,4-benzoxazepin-5(4H)-one),osemozotan(5-(3-[((2S)-1,4-benzodioxan-2-ylmethyl)amino]propoxy)-1,3-benzodioxole),flesinoxan(4-fluoro-N-[2-[4-[(3S)-3-(hydroxymethyl)-2,3-dihydro-1,4-benzodioxin-8-yl]piperazin-1-yl]ethyl]benzamide),flibanserin(1-(2-{4-[3-(trifluoromethyl)phenyl]piperazin-1-yl}ethyl)-1,3-dihydro-2H-benzimidazol-2-one),sarizotan (EMD-128,130)(1-[(2R)-3,4-dihydro-2H-chromen-2-yl]-N-([5-(4-fluorophenyl)pyridin-3-yl]-methyl)methanamine)or a pharmaceutically acceptable derivative thereof.

In one embodiment of the present invention, the 5-HT1A agonist is apartial agonist of the 5-HT1A receptor.

In a preferred embodiment of the present invention, the 5-HT1A agonistis buspirone, tandospirone or gepirone or a pharmaceutically acceptablederivative thereof.

In an even more preferred embodiment of the present invention, the5-HT1A agonist is buspirone or tandospirone or a pharmaceuticallyacceptable derivative thereof.

According to the present invention, a combined 5-HT1B and 5-HT1Dreceptor agonist or a pharmaceutically acceptable derivative thereof,may be used in combination with a 5-HT1A receptor agonist or apharmaceutically acceptable derivative thereof. Thus according to thepresent invention, sumatriptan is used in combination with alnespirone,or sumatriptan is used in combination with binospirone, or sumatriptanis used in combination with buspirone, or sumatriptan is used incombination with gepirone, or sumatriptan is used in combination withipsapirone, or sumatriptan is used in combination with perospirone, orsumatriptan is used in combination with tandospirone, or sumatriptan isused in combination with befiradol, or sumatriptan is used incombination with repinotan, or sumatriptan is used in combination withpiclozotan, or sumatriptan is used in combination with osemozotan, orsumatriptan is used in combination with flesinoxan, or sumatriptan isused in combination with flibanserin, or sumatriptan is used incombination with sarizotan, or zolmitriptan is used in combination withalnespirone, or zolmitriptan is used in combination with binospirone, orzolmitriptan is used in combination with buspirone, or zolmitriptan isused in combination with gepirone, or zolmitriptan is used incombination with ipsapirone, or zolmitriptan is used in combinationwith, or zolmitriptan is used in combination with perospirone, orzolmitriptan is used in combination with tandospirone, or zolmitriptanis used in combination with befiradol, or zolmitriptan is used incombination with repinotan, or zolmitriptan is used in combination withpiclozotan, or zolmitriptan is used in combination with osemozotan, orzolmitriptan is used in combination with flesinoxan, or zolmitriptan isused in combination with flibanserin, or zolmitriptan is used incombination with sarizotan, or rizatripan is used in combination withalnespirone, or rizatripan is used in combination with binospirone, orrizatripan is used in combination with buspirone, or rizatripan is usedin combination with gepirone, or rizatripan is used in combination withipsapirone, or rizatripan is used in combination with perospirone, orrizatripan is used in combination with tandospirone, or rizatripan isused in combination with befiradol, or rizatripan is used in combinationwith repinotan, or rizatripan is used in combination with piclozotan, orrizatripan is used in combination with osemozotan, or rizatripan is usedin combination with flesinoxan, or rizatripan is used in combinationwith flibanserin, or rizatripan is used in combination with sarizotan,or naratripan is used in combination with alnespirone, or naratripan isused in combination with binospirone, or naratripan is used incombination with buspirone, or naratripan is used in combination withgepirone, or naratripan is used in combination with ipsapirone, ornaratripan is used in combination with perospirone, or naratripan isused in combination with tandospirone, or naratripan is used incombination with befiradol, or naratripan is used in combination withrepinotan, or naratripan is used in combination with piclozotan, ornaratripan is used in combination with osemozotan, or naratripan is usedin combination with flesinoxan, or naratripan is used in combinationwith flibanserin, or naratripan is used in combination with sarizotan,or almotriptan is used in combination with alnespirone, or almotriptanis used in combination with binospirone, or almotriptan is used incombination with buspirone, or almotriptan is used in combination withgepirone, or almotriptan is used in combination with ipsapirone, oralmotriptan is used in combination with perospirone, or almotriptan isused in combination with tandospirone, or almotriptan is used incombination with befiradol, or almotriptan is used in combination withrepinotan, or almotriptan is used in combination with piclozotan, oralmotriptan is used in combination with osemozotan, or almotriptan isused in combination with flesinoxan, or almotriptan is used incombination with flibanserin, or almotriptan is used in combination withsarizotan, or frovatriptan is used in combination with alnespirone, orfrovatriptan is used in combination with binospirone, or frovatriptan isused in combination with buspirone, or frovatriptan is used incombination with gepirone, or frovatriptan is used in combination withipsapirone, or frovatriptan is used in combination with perospirone, orfrovatriptan is used in combination with tandospirone, or frovatriptanis used in combination with befiradol, or frovatriptan is used incombination with repinotan, or frovatriptan is used in combination withpiclozotan, or frovatriptan is used in combination with osemozotan, orfrovatriptan is used in combination with flesinoxan, or frovatriptan isused in combination with flibanserin, or frovatriptan is used incombination with sarizotan, or eletriptan is used in combination withalnespirone, or eletriptan is used in combination with binospirone, oreletriptan is used in combination with buspirone, or eletriptan is usedin combination with gepirone, or eletriptan is used in combination withipsapirone, or eletriptan is used in combination with perospirone, oreletriptan is used in combination with tandospirone, or eletriptan isused in combination with befiradol, or eletriptan is used in combinationwith repinotan, or eletriptan is used in combination with piclozotan, oreletriptan is used in combination with osemozotan, or is used incombination with flesinoxan, or eletriptan is used in combination withflibanserin, or eletriptan is used in combination with sarizotan.

In a more preferred embodiment of the present invention, the combined5-HT1B and 5-HT1D receptor agonist is selected from the group ofzolmitriptan and frovatriptan, or a pharmaceutically acceptablederivative thereof and the 5-HT1A receptor agonist is selected frombuspirone, tandospirone or gepirone or a pharmaceutically acceptablederivative thereof. Even more preferably the combined 5-HT1B and 5-HT1Dreceptor agonist compound is zolmitriptan or a pharmaceuticallyacceptable derivative thereof and the 5-HT1A receptor agonist isbuspirone or a pharmaceutically acceptable derivative thereof.

According to the present invention, a 5-HT1F receptor agonist or apharmaceutically acceptable derivative thereof may be used incombination with a 5-HT1A receptor agonist. Such 5-HT1F receptoragonists may be selected from the group of COL-144 (also called LY573144or lasmiditan), LY334370, or LY344864.

According to the present invention, a 5-HT1F receptor agonist or apharmaceutically acceptable derivative thereof may be used incombination with a 5-HT1A receptor agonist or a pharmaceuticallyacceptable derivative thereof. Thus according to the present invention,COL-144 is used in combination with alnespirone, or COL-144 (lasmiditan)is used in combination with alnespirone, or COL-144 (lasmiditan) is usedin combination with binospirone, or COL-144 is used in combination withbuspirone, or COL-144 is used in combination with gepirone, or COL-144is used in combination with ipsapirone, or COL-144 is used incombination with perospirone, or COL-144 is used in combination withtandospirone, or COL-144 is used in combination with befiradol, orCOL-144 is used in combination with repinotan, or COL-144 is used incombination with piclozotan, or COL-144 is used in combination withosemozotan, or COL-144 is used in combination with flesinoxan, orCOL-144 is used in combination with flibanserin, or COL-144 is used incombination with sarizotan, or LY573144 is used in combination withalnespirone, or LY573144 is used in combination with binospirone, orLY573144 is used in combination with buspirone, or LY573144 is used incombination with gepirone, or COL-144 is used in combination withipsapirone, or LY573144 is used in combination with perospirone, orLY573144 is used in combination with tandospirone, or LY573144 is usedin combination with befiradol, or LY573144 is used in combination withrepinotan, or LY573144 is used in combination with piclozotan, orLY573144 is used in combination with osemozotan, or LY573144 is used incombination with flesinoxan, or LY573144 is used in combination withflibanserin, or LY573144 is used in combination with sarizotan, orLY334370 is used in combination with alnespirone, or LY334370 is used incombination with binospirone, or LY334370 is used in combination withbuspirone, or LY334370 is used in combination with gepirone, or LY334370is used in combination with ipsapirone, or LY334370 is used incombination with perospirone, or LY334370 is used in combination withtandospirone, or LY334370 is used in combination with befiradol, orLY334370 is used in combination with repinotan, or LY334370 is used incombination with piclozotan, or LY334370 is used in combination withosemozotan, or LY334370 is used in combination with flesinoxan, orLY334370 is used in combination with flibanserin, or LY334370 is used incombination with sarizotan, or LY344864 is used in combination withalnespirone, or LY344864 is used in combination with binospirone, orLY344864 is used in combination with buspirone, or LY344864 is used incombination with gepirone, or LY344864 is used in combination withipsapirone, or LY344864 is used in combination with perospirone, orLY344864 is used in combination with tandospirone, or LY344864 is usedin combination with befiradol, or LY344864 is used in combination withrepinotan, or LY344864 is used in combination with piclozotan, orLY344864 is used in combination with osemozotan, or LY344864 is used incombination with flesinoxan, or LY344864 is used in combination withflibanserin, or LY344864 is used in combination with sarizotan or apharmaceutically acceptable derivative thereof.

In a preferred embodiment of the present invention, COL-144 is used incombination with buspirone or gepirone.

In yet a preferred embodiment of the present invention, COL-144 is usedin combination with tandospirone.

Movement Disorders

The present invention relates to treatment of movement disorders, suchas disorders which are associated with altered or impaired synapticdopamine levels. Movement disorders according to the present inventionmay be selected from the group of disorders comprising ataxia,akathisia, dystonia, essential tremor, Huntington's disease, myoclonus,Parkinson's disease, Rett syndrome, tardive dyskinesia, Tourettesyndrome, Wilson's disease, dyskinesia, chorea, Machado-Joseph disease,restless leg syndrome, spasmodic torticollis, geniospasm, or movementdisorders associated therewith.

Movement disorders according to the present invention may also beassociated with use of neuroleptic drugs, idiopathic disease, geneticdysfuntions, infections or other conditions which lead to dysfunction ofthe basal ganglia and/or lead to altered synaptic DA levels.

In one preferred embodiment of the present invention, the treatment isof one or more movement disorders selected from group of akathisia,tarditive dyskinesia, Parkinson's disease, movement disorders associatedwith Parkinson's disease, such as bradykinesia, akinesia and dyskinesiafor example L-DOPA induced dyskinesia.

Parkinson's disease is associated with muscle rigidity, tremor, posturalabnormalities, gait abnormalities, a slowing of physical movement(bradykinesia), and in extreme cases a loss of physical movement(akinesia). PD is caused by degeneration and death of dopaminergicneurons in substantia nigra pars compacta, and leads to dysfunctionalregulation of dopamine neurotransmission.

In one particularly preferred embodiment of the present invention themovement disorder is Parkinson's disease or associated movementdisorders akinesia, dyskinesia and bradykinesia. Another particularlypreferred embodiment of the present invention is treatment of movementdisorders associated with Parkinson's disease such as L-DOPA induceddyskinesia. A third particularly preferred embodiment of the presentinvention is the treatment of movement disorders associated withParkinson's disease such as akinesia.

In one preferred embodiment of the present invention, the movementdisorder is tardive dyskinesia.

In another embodiment of the present invention, the movement disorder iscaused by or associated with medication of antipsychotics such ashaloperidol, droperidol, pimozide, trifluoperazine, amisulpride,risperidone, aripiprazole, asenapine, and zuclopenthixol,antidepressants such as fluoxetine, paroxetine, venlafaxine, andtrazodone, anti-emetic drugs such as dopamine blockers for examplemetoclopramide (reglan) and prochlorperazine (compazine).

In yet another embodiment of the present invention, the movementdisorder is caused by or associated with withdrawal of opioids,barbiturates, cocaine, benzodiazepines, alcohol, or amphetamines.

Dosage

The combination of compounds and pharmaceutical compositions of thepresent invention induces combined or synergistic effects, which enablefor a lowered dosage of 5-HT1 agonists in the treatment of movementdisorders. The lowered dosage scheme further results in a reduced riskof adverse effects of treatment with 5-HT1 agonists, such as reducingthe risk of developing serotonin syndrome.

According to the present invention, 5-HT1 agonists are administered toindividuals in need of treatment in pharmaceutically effective doses. Atherapeutically effective amount of a compound according to the presentinvention is an amount sufficient to cure, prevent, reduce the risk of,alleviate or partially arrest the clinical manifestations of a givendisease or movement disorder and its complications. The amount that iseffective for a particular therapeutic purpose will depend on theseverity and the sort of the movement disorder as well as on the weightand general state of the subject. The 5-HT1 agonists of the presentinvention may be administered one or several times per day, such as from1 to 4 times per day, such as from 1 to 3 times per day, such as from 1to 2 times per day, wherein administration from 1 to 3 times per day ispreferred.

In one embodiment of the present invention, the compound is either a) acombined 5-HT1B, 5-HT1D agonist and/or 5-HT1F agonist, or b) a selective5-HT1D receptor agonist, or c) a selective 5-HT1F receptor agonist, andis administered in doses of 0.5 mg/day to 100 mg/day, such as 0.5 mg/dayto 1 mg/day, such as 1 mg/day to 2 mg/day, such as 2 mg/day to 5 mg/day,or such as 5 mg/day to 10 mg/day, or such as 5 mg/day to 10 mg/day, orsuch as 10 mg/day to 20 mg/day, or such as 20 mg/day to 30 mg/day, orsuch as 30 mg/day to 40 mg/day, or such as 40 mg/day to 50 mg/day, orsuch as 40 mg/day to 60 mg/day, or such as 60 mg/day to 70 mg/day, orsuch as 70 mg/day to 80 mg/day, or such as 80 mg/day to 90 mg/day, orsuch as 90 mg/day to 95 mg/day, or such as 95 mg/day to 98 mg/day, orsuch as 98 mg/day to 100 mg/day.

In another embodiment of the present invention, the compound is eithera) a combined 5-HT1B, 5-HT1D agonist and/or 5-HT1F agonist, or b) aselective 5-HT1D receptor agonist, or c) a selective 5-HT1F receptoragonist and is administered in doses of 0.5 mg/day to 200 mg/day, suchas in the range of 0.5 mg/day to 60 mg/day, such as 0.05 mg/day to 0.1mg/day, or such as 0.1 to 0.5 mg/day, or such as in the range of 0.5mg/day to 60 mg/day, such as in the range of 0.5 to 30 mg/day, such assuch as 0.5 to 5 mg/day, or such as 5 mg/day to 10 mg/day, or such as 10mg/day to 15 mg/day, or such as 15 mg/day to 30 mg/day.

In a preferred embodiment of the present invention, the compound iseither a) a combined 5-HT1B, 5-HT1D receptor agonist and/or 5-HT1Freceptor agonist, or b) a selective 5-HT1D receptor agonist, or c) aselective 5-HT1F receptor agonist and is administered in doses of 0.5mg/day to 200 mg/day, preferably in doses of 0.5 mg/day to 60 mg/day andeven more preferably in doses of 0.5 mg/day to 10 mg/day.

In yet a preferred embodiment of the present invention, zolmitriptan isadministered in doses of 0.5 mg/day to 30 mg/day and more preferably indoses of 0.5 mg/day to 10 mg/day.

In one embodiment of the present invention, a single dose of thecompound that is either a) a combined 5-HT1B, 5-HT1D receptor agonistand/or 5-HT1F receptor agonist, or b) a selective 5-HT1D receptoragonist, or c) a selective 5-HT1F receptor agonist are administered andmay comprise of 0.05 mg/kg bodyweight to 100 mg/kg bodyweight, such asin the range of 0.05 mg/kg bodyweight to 20 mg/kg bodyweight, such as0.05 mg/kg bodyweight to 0.1 mg/kg bodyweight, or such as 0.1 to 0.5mg/kg bodyweight, or such as in the range of 0.5 mg/kg bodyweight to 10mg/kg bodyweight, such as such as 0.5 mg/kg bodyweight to 1 mg/kgbodyweight, such as 1 mg/kg bodyweight to 2 mg/kg bodyweight, such as 2mg/kg bodyweight to 5 mg/kg bodyweight, or such as 5 mg/kg bodyweight to10 mg/kg bodyweight.

In a preferred embodiment a single dose of the compound that is eithera) a combined 5-HT1B, 5-HT1D receptor agonist and/or 5-HT1F receptoragonist, or b) a selective 5-HT1D receptor agonist, or c) a selective5-HT1F receptor agonist is in the range of 0.05 mg/kg bodyweight to 10mg/kg bodyweight.

According to the present invention, a compound which is a combined5-HT1B, 5-HT1D agonist and/or 5-HT1F agonist can have different affinityand/or receptor activation efficacy for the different 5-HT1 receptors.Thus, when using certain doses of such compounds, it may be possible tostimulate the 5-HT1 receptors do different extends, due to a moreefficient activation of one type of 5-HT1 receptor than another type of5-HT1 receptor. For instance some doses of compounds may triggerresponses from only one 5-HT1 receptor, or some doses of compounds maytrigger a moderate response from one 5-HT receptor, while another typeof 5-HT1 receptor is triggered to result in a full response, or aminimal response. One method for measuring the extent of receptoractivation is to measure the response at a certain dose relative to thefull response (Emax).

In one embodiment of the present invention, a compound is used in doseswherein said dose mediates an activation of the 5-HT1D receptor which ishigher than the activation of the 5-HT1B receptor. Thus, the measuredresponse of the 5-HT1B receptor compared to the 5-HT1D receptor can bein the range of 1% to 99% of the response of the 5-HT1D receptor, suchas in the range of 1% to 15%, such as 1% to 10%, or such as 10% to 15%,or such as in the range of 15% to 35%, such as 15% to 25%, or such as25% to 35%, or such as in the range of 35% to 55%, such as 35% to 45%,or such as 45% to 55%, or such as in the range of 55% to 75%, such as55% to 65%, or such as 65% to 75%, or such as in the range of 95% to99%, such as 95% to 97%, or such as 97% to 98%, or such as 98% to 99%.

The present invention relates to dosages of 5-HT1A agonists which areadministered in doses of 0.5 mg/day to 100 mg/day, such as 0.5 mg/day to1 mg/day, such as 1 mg/day to 2 mg/day, such as 2 mg/day to 5 mg/day, orsuch as 5 mg/day to 10 mg/day, or such as 5 mg/day to 10 mg/day, or suchas 10 mg/day to 20 mg/day, or such as 20 mg/day to 30 mg/day, or such as30 mg/day to 40 mg/day, or such as 40 mg/day to 50 mg/day, or such as 40mg/day to 60 mg/day, or such as 60 mg/day to 70 mg/day, or such as 70mg/day to 80 mg/day, or such as 80 mg/day to 90 mg/day, or such as 90mg/day to 95 mg/day, or such as 95 mg/day to 98 mg/day, or such as 98mg/day to 100 mg/day.

The 5-HT1A receptor agonist can according to the present invention beadministered in doses in the range of 0.05 mg/day to 500 mg/day, such as0.05 mg/day to 0.1 mg/day, such as 0.1 mg/day to 0.5 mg/day, preferablyin the range of 0.5 mg/day to 100 mg/day, and even more preferably inthe range of 0.5 mg/day to 30 mg/day, such as 0.5 mg/day to 1 mg/day, orsuch as 1 mg/day to 2 mg/day, or such as 2 mg/day to 5 mg/day, or suchas 5 mg/day to 10 mg/day, or such as 10 mg/day to 15 mg/day, or such as15 mg/day to 20 mg/day, or such as 20 mg/day to 30 mg/day.

In a preferred embodiment of the present invention, a single dose of5-HT1A agonist is in the range of 0.5 to 100 mg/day and even morepreferred in doses of 0.5 to 30 mg/day.

In a preferred embodiment of the present invention, the 5-HT1A agonistis administered in doses of 0.5 mg/day to 100 mg/day and the compound isa combined agonist of two or more of the 5-HT1B, the 5-HT1D and the5-HT1F receptors, or a selective 5-HT1D agonist, or a selective 5-HT1Fagonist and is administered in doses of 0.1 mg/day to 60 mg/day, evenmore preferably the 5-HT1A agonist is administered in doses of 0.5mg/day to 30 mg/day and the compound is a combined agonist of two ormore of the 5-HT1B, the 5-HT1D and the 5-HT1F receptors, or a selective5-HT1D agonist, or a selective 5-HT1F agonist and is administered indoses of 0.1 mg/day to 10 mg/day.

In yet a preferred embodiment of the present invention, buspirone isadministered in doses of 0.5 mg/day to 100 mg/day and zolmitriptan isadministered in doses of 0.5 mg/day to 60 mg/day, and even morepreferably, buspirone is administered in doses of 0.5 to 30 mg/day andzolmitriptan is administered in doses of 0.5 to 10 mg/day.

In one embodiment of the present invention, a single dose of 5-HT1Areceptor agonist can be in the range of 0.05 mg/kg bodyweight to 100mg/kg bodyweight, such as in the range of 0.05 mg/kg bodyweight to 20mg/kg bodyweight, such as 0.05 mg/kg bodyweight to 0.1 mg/kg bodyweight,or such as 0.1 to 0.5 mg/kg bodyweight, or such as in the range of 0.5mg/kg bodyweight to 10 mg/kg bodyweight, such as such as 0.5 mg/kgbodyweight to 1 mg/kg bodyweight, such as 1 mg/kg bodyweight to 2 mg/kgbodyweight, such as 2 mg/kg bodyweight to 5 mg/kg bodyweight, or such as5 mg/kg bodyweight to 10 mg/kg bodyweight.

In a preferred embodiment a single dose of the 5-HT1A agonist is in therange of 0.05 mg/kg bodyweight to 10 mg/kg bodyweight.

Second Active Ingredients

The compounds or pharmaceutical compositions of the present inventionmay be combined with or comprise one or more second active ingredientswhich are understood as other therapeutical compounds orpharmaceutically acceptable derivatives thereof. In one particularlypreferred embodiment of the present invention, a 5-HT1A agonist asmentioned herein is regarded as a second active ingredient.

A second active ingredient according to the present invention mayfurther be one or more agents selected from the group of agentsincreasing the dopamine concentration in the synaptic cleft, dopamine,L-DOPA or dopamine receptor agonists or derivatives thereof. Thus,according to the present invention second active ingredients comprise DAreceptor agonists, such as bromocriptine, pergolide, pramipexole,ropinirole, piribedil, cabergoline, apomorphine, lisuride, andderivatives thereof.

Second active ingredients may further be selected from the group ofcompounds which ameliorate PD symptoms or which are used for treatmentof PD, such as peripheral inhibitors of the transformation of L-DOPA or(other dopamine prodrugs) to dopamine, for example carboxylaseinhibitors such as carbidopa or benserazide, or NMDA antagonists such asfor example amatidine (Symmetrel), catechol-O-methyl transferase (COMT)inhibitors such as for example tolcapone and entacapone, MAO-Binhibitors such as for example selegiline and rasagiline, serotoninreceptor modulators, kappa opioid receptors agonists such as for exampleTRK-820((E)-N-[17-cyclopropylmethyl)-4,5α-epoxy-3,14-dihydroxymorphinan-6β-yl]-3-(furan-3-yl)-N-methylprop-2-enamidemonohydrochloride), GABA modulators, modulators of neuronal potassiumchannels such as flupirtine and retigabine, and glutamate receptormodulators.

In a preferred embodiment of the present invention, a second activeingredient is a dopamine prodrug, such as L-DOPA or a pharmaceuticallyacceptable derivative thereof. Thus in one preferred embodiment, L-DOPAis used in combination with a combined 5-HT1B and 5-HT1D receptoragonist selected from the group of zolmitriptan and frovatriptan or apharmaceutically acceptable derivative thereof, and a 5-HT1A receptoragonist selected from buspirone, tandospirone or gepirone or apharmaceutically acceptable derivative thereof, Even more preferablyL-DOPA is used in combination with zolmitriptan and buspirone or apharmaceutically acceptable derivative thereof.

In one embodiment of the present invention, the compounds orpharmaceutical compositions may be combined with two or more secondactive ingredients. Such two second active ingredients may be L-DOPA incombination with a carboxylase inhibitor. Thus in an embodiment of thepresent invention, the two or more second active ingredients compriseL-DOPA and carbidopa, or L-DOPA and benserazide.

In another embodiment, such two second active ingredients are L-DOPA incombination with a COMT inhibitor, wherein the COMT inhibitor can betolcapone, or entacapone.

The second active ingredients according to the present invention canalso be included in the same formulations such as for example theL-DOPA/benserazide formulations sinemet, parcopa, madopar, orL-DOPA/COMT inhibitor formulations such as for example stalevo.

Methods of Treatment

The present invention provides methods for treatment, prevention oralleviation of movement disorders as mention herein. Such methodsaccording to the present invention comprise one or more steps ofadministration of an effective amount of a pharmaceutical composition ora compound according to the present invention to an individual in needthereof. Such steps of administration may be simultaneous, sequential orseparate.

In a preferred method of treatment according to the present invention,the compound or pharmaceutical composition comprises zolmitriptan,frovatriptan, eletriptan or COL144 or pharmaceutically acceptablederivative thereof, more preferably the compound or pharmaceuticalcomposition comprises zolmitriptan or pharmaceutically acceptablederivative thereof.

Methods for treatment according to the present invention may furthercomprise one or more steps of administration of one or more secondactive ingredients as defined herein.

In one particular embodiment of the present invention, thepharmaceutical composition or the compound as defined herein isadministered simultaneously, sequentially or separately in combinationwith an effective amount of a 5-HT1A agonist.

In a preferred embodiment of the present invention, the pharmaceuticalcomposition or compound as defined herein is administeredsimultaneously, sequentially or separately in combination with aneffective amount of a 5-HT1A agonist selected from the group ofalnespirone, binospirone, buspirone, gepirone, ipsapirone, perospirone,tandospirone, befiradol, repinotan, piclozotan, osemozotan, flesinoxan,flibanserin and sarizotan or a derivative thereof.

In a more preferred embodiment of the present invention, buspirone,tandospirone or gepirone or a derivative thereof is used in a method oftreatment.

In a most preferred embodiment of the present invention, the 5-HT1Aagonist is buspirone or pharmaceutically acceptable derivative thereof.

Thus, in a most preferred method of the present invention, the compoundor pharmaceutical composition comprises zolmitriptan or apharmaceutically acceptable derivative thereof and the 5-HT1A agonist isbuspirone or pharmaceutically acceptable derivative thereof.

In methods of the present invention, a compound or a pharmaceuticalcomposition according to the present invention may be administered aloneor in combination with one or more other second active ingredients,either concomitantly or sequentially, and in any suitable ratios. Suchsecond active ingredients may, for example, be selected from compoundsused to treat or prevent Parkinson's disease or symptoms andcomplications associated with Parkinson's disease.

Methods of treatment according to the present invention may include astep wherein the pharmaceutical composition or compound as definedherein is administered simultaneously, sequentially or separately incombination with one or more second active ingredients as definedherein.

In a preferred embodiment of the present invention, a second activeingredient used in a method provided by the invention is a dopamineprodrug, such as L-DOPA.

Thus in one preferred embodiment, the second active ingredient L-DOPA isused in combination with a combined 5-HT1B and 5-HT1D receptor agonistselected from the group of zolmitriptan and frovatriptan or apharmaceutically acceptable derivative thereof, and a 5-HT1A receptoragonist selected from buspirone, tandospirone or gepirone or apharmaceutically acceptable derivative thereof, Even more preferablyL-DOPA is used in combination with zolmitriptan and buspirone or apharmaceutically acceptable derivative thereof.

In the methods for treatment according to the present invention, thecompounds or pharmaceutical compositions as defined herein areadministered in doses as referred to herein.

Further, in the methods for treatment according to the presentinvention, the 5-HT1A agonist is administered in doses as referred toherein.

The administration of compounds, pharmaceutical compositions and secondactive ingredients according to the present invention may beadministered to an individual during at various time points oftreatment. The treatment may be done over one continued period, or inintervals with periods in between wherein the administration of one ormore compounds, pharmaceutical compositions and second activeingredients according to the present invention is stopped, decreased oraltered. Such treatment periods or non-treatment periods may vary inlength, and can be from 1 day to 60 days, such as 1 to 3 days, 3 to 6days, 6 to 8 days, 8 to 14 days, 14 to 21 days, 21 to 30 days, 30 to 42days, 42 to 49 days or 49 to 60 days.

Kit of Parts

The present invention provides kits of parts which can be useful fortreatment of movement disorders as described herein.

A kit of parts according to the present invention comprises one or moreof the pharmaceutical compositions or compounds as defined herein fortreatment, prevention or alleviation of movement disorders. Kitsaccording to the present invention allows for simultaneous, sequentialor separate administration of the pharmaceutical compositions, compoundsor second active ingredients described herein.

In one embodiment of the present invention, the kit of parts comprisesone or more second active ingredients as described herein.

In a preferred embodiment of the present invention, the kit of partscomprises a 5-HT1A agonist such as for example alnespirone, binospirone,buspirone, gepirone, ipsapirone, perospirone, tandospirone, befiradol,repinotan piclozotan, osemozotan, flesinoxan, flibanserin and sarizotanor a derivative thereof.

In a highly preferred embodiment of the present invention, the kits ofparts comprises buspirone, tandospirone or gepirone or a derivativethereof.

In a most preferred method of the present invention, the compound orpharmaceutical composition comprises zolmitriptan or a pharmaceuticallyacceptable derivative thereof, and the 5-HT1A agonist is buspirone orpharmaceutically acceptable derivative thereof.

In a preferred embodiment of the present invention, a second activeingredient comprised in a kit provided by the invention is a dopamineprodrug, such as L-DOPA.

Thus in one preferred embodiment, a kit of parts comprises a combined5-HT1B and 5-HT1D receptor agonist selected from the group ofzolmitriptan and frovatriptan or a pharmaceutically acceptablederivative thereof, and can further comprise a 5-HT1A receptor agonistselected from buspirone, tandospirone or gepirone or a pharmaceuticallyacceptable derivative thereof, and a second active ingredient selectedfrom L-DOPA or a pharmaceutically acceptable derivative thereof.

Method of Preparation

The present invention provides methods for the preparation of thepharmaceutical compositions as defined herein.

A method for preparation according to the present invention may compriseat least a step wherein a) either a combined 5-HT1B, 5-HT1D agonistand/or 5-HT1F receptor agonist, or a selective 5-HT1D receptor agonistor a selective 5-HT1F receptor agonist, is mixed with b) a 5-HT1Aagonist to produce a composition which comprises one or more of c)selective 5-HT1A agonist, and d) a combined 5-HT1B, 5-HT1D agonistand/or 5-HT1F agonist, or a selective 5-HT1F receptor agonist or aselective 5-HT1F receptor agonist.

The methods for preparation may further comprise a step whereincompounds for formulation as mentioned herein are added to a mixture ofone or more of a) selective 5-HT1A agonists, and one or more of b)compounds which are combined 5-HT1B, 5-HT1D agonist and/or 5-HT1Fagonist, or a selective 5-HT1D receptor agonist, or a selective 5-HT1Fagonist.

A method for preparation according to the present invention may compriseat least a step wherein a) either a combined 5-HT1B, 5-HT1D agonistand/or 5-HT1F receptor agonist, or a selective 5-HT1D receptor agonistor a selective 5-HT1F receptor agonist, is mixed with b) a 5-HT1Aagonist to produce a composition which comprises one or more of c) apartial or selective 5-HT1A agonist, and d) a combined 5-HT1B, 5-HT1Dagonist and/or 5-HT1F agonist, or a selective 5-HT1F receptor agonist ora selective 5-HT1F receptor agonist.

The methods for preparation may further comprise a step whereincompounds for formulation as mentioned herein are added to a mixture ofone or more of a) a partial or selective 5-HT1A agonists, and one ormore of b) compounds which are combined 5-HT1B, 5-HT1D agonist and/or5-HT1F agonist, or a selective 5-HT1D receptor agonist, or a selective5-HT1F agonist.

In one preferred embodiment of the present invention a method forpreparation according to the present invention may comprise at least astep wherein a) one or more combined 5-HT1B, 5-HT1D agonist and/or5-HT1F receptor agonist selected from the group of zolmitriptan,rizatriptan, naratriptan and frovatriptan is mixed with b) one or more5-HT1A agonists selected from the group if buspirone, tandospirone orgepirone to produce a composition comprising one or more which comprisesone or more of combined 5-HT1B, 5-HT1D agonist and/or 5-HT1F receptoragonist and one or more 5-HT1A agonists.

In a more preferred embodiment of the present invention, a method forpreparation according to the present invention may comprise at least astep wherein a) zolmitriptan is mixed with a composition comprising b)buspirone, to produce a composition comprising both zolmitriptan andbuspirone.

Routes of Administration

It will be appreciated that the preferred route of administration willdepend on the general condition and age of the subject to be treated,the nature of the condition to be treated, the location of the tissue tobe treated in the body and the active ingredient chosen.

In one embodiment of the present invention, the route of administrationallows for the agent to cross the blood-brain barrier.

Systemic Treatment

Systemic treatment according to the present invention the route ofadministration is capable of introducing the agent into the blood streamto ultimately target the sites of desired action.

Such routes of administration are any suitable routes, such as anenteral route, the oral, rectal, nasal, pulmonary, buccal, sublingual,transdermal, intracisternal, intraperitoneal, and parenteral (includingsubcutaneous, intramuscular, intrathecal, intravenous and intradermal)route, wherein the oral route is preferred.

Appropriate dosage forms for such administration may be prepared byconventional techniques.

Oral Administration

Oral administration is normally for enteral drug delivery, wherein theagent is delivered through the enteral mucosa. In a preferred embodimentof the present invention, the compounds and pharmaceutical compositionsas defined herein are administered orally.

Parenteral Administration

Parenteral administration is any administration route not being theoral/enteral route whereby the medicament avoids first-pass degradationin the liver. Accordingly, parenteral administration includes anyinjections and infusions, for example bolus injection or continuousinfusion, such as intravenous administration, intramuscularadministration, subcutaneous administration. Furthermore, parenteraladministration includes inhalations and topical administration.

Accordingly, the agent may be administered topically to cross anymucosal membrane of an animal to which the biologically active substanceis to be given, e.g. in the nose, vagina, eye, mouth, genital tract,lungs, gastrointestinal tract, or rectum, preferably the mucosa of thenose, or mouth, and accordingly, parenteral administration may alsoinclude buccal, sublingual, nasal, rectal, vaginal and intraperitonealadministration as well as pulmonal and bronchial administration byinhalation or installation. Also, the agent may be administeredtopically to cross the skin.

The subcutaneous and intramuscular forms of parenteral administrationare generally preferred.

Local Treatment

The agent according to the invention may be used as a local treatment,ie. be introduced directly to the site(s) of action as will be describedbelow.

Accordingly, the agent may be applied to the skin or mucosa directly, orthe agent may be injected into the site of action, for example into thediseased tissue or to an end artery leading directly to the diseasedtissue.

Pharmaceutical Formulations

The 5-HT1 agonists or pharmaceutically acceptable derivatives thereof ofthe present invention may be administered alone or in combination withpharmaceutically acceptable carriers or excipients, in either single ormultiple doses. The pharmaceutical compositions or compounds accordingto the invention may be formulated with pharmaceutically acceptablecarriers or diluents as well as any other known adjuvants and excipientsin accordance with conventional techniques such as those disclosed inRemington: The Science and Practice of Pharmacy, 20^(th) Edition,Gennaro, Ed., Mack Publishing Co., Easton, Pa., 2000.

The pharmaceutical composition may be specifically formulated foradministration by any suitable route, such as an enteral route, theoral, rectal, nasal, pulmonary, buccal, sublingual, transdermal,intracisternal, intraperitoneal, and parenteral (including subcutaneous,intramuscular, intrathecal, intravenous and intradermal) route, whereinthe oral route is preferred.

In a preferred embodiment of the present invention, the pharmaceuticalcompositions or compounds of the present invention are formulated forcrossing the blood-brain-barrier.

Pharmaceutical compositions for oral administration include solid dosageforms such as hard or soft capsules, tablets, troches, dragees, pills,lozenges, powders and granules. Where appropriate, they can be preparedwith coatings such as enteric coatings, or they can be formulated so asto provide controlled release of the active ingredient, such assustained or prolonged release, according to methods well known in theart.

Liquid dosage forms for oral administration include solutions,emulsions, aqueous or oily suspensions, syrups and elixirs.

Pharmaceutical compositions for parenteral administration includesterile aqueous and non-aqueous injectable solutions, dispersions,suspensions or emulsions, as well as sterile powders to be reconstitutedin sterile injectable solutions or dispersions prior to use. Depotinjectable formulations are also regarded as being within the scope ofthe present invention.

Other suitable administration forms include suppositories, sprays,ointments, cremes, gels, inhalants, dermal patches, implants, etc.

A compound or a 5-HT1 agonist for use according to the present inventionis generally utilized as the free substance or as a pharmaceuticallyderivative such as a pharmaceutically acceptable ester or such as a saltthereof. Examples of the latter are: an acid addition salt of a compoundhaving a free base functionality, and a base addition salt of a compoundhaving a free acid functionality. The term “pharmaceutically acceptablesalt” refers to a non-toxic salt of a compound for use according to thepresent invention, which salts are generally prepared by reacting a freebase with a suitable organic or inorganic acid, or by reacting an acidwith a suitable organic or inorganic base. When a compound for useaccording to the present invention contains a free base functionality,such salts are prepared in a conventional manner by treating a solutionor suspension of the compound with a chemical equivalent of apharmaceutically acceptable acid. When a compound for use according tothe present invention contains a free acid functionality, such salts areprepared in a conventional manner by treating a solution or suspensionof the compound with a chemical equivalent of a pharmaceuticallyacceptable base. Physiologically acceptable salts of a compound with ahydroxy group include the anionic form of the compound in combinationwith a suitable cation, such as sodium or ammonium ion. Other saltswhich are not pharmaceutically acceptable may be useful in thepreparation of compounds of the invention, and these form a furtheraspect of the invention. Pharmaceutically acceptable acid addition saltsinclude, but are not limited to, hydrochloride, hydrobromide,hydroiodide, nitrate, sulfate, bisulfate, phosphate, acid phosphate,isonicotinate, acetate, lactate, salicylate, citrate, tartrate,pantothenate, bitartrate, ascorbate, succinate, maleate, gentisinate,fumarate, gluconate, glucaronate, saccharate, formate, benzoate,glutamate, methanesulfonate, ethanesulfonate, benzensulfonate,p-toluenesulfonate and pamoate (i.e.,1,1′-methylene-bis-(2-hydroxy-3-naphthoate)) salts.

In a specific embodiment, compounds of the present invention are used asacid addition salts formed with mineral acids such as hydrochloric acidand hydrobromic acid, and, especially, hydrochloric acid. An example ofsuch a salt is for example buspirone hydrochloride.

In one embodiment of the present invention, the 5-HT1 agonists of thepresent invention is on crystalline forms, for example co-crystallizedforms or hydrates of crystalline forms.

The term “prodrug” refers to compounds that are rapidly transformed invivo to yield the parent compound of the above formulae, for example, byhydrolysis in blood or by metabolism in cells, such as for example thecells of the basal ganglia. A thorough discussion is provided in T.Higuchi and V Stella, “Pro-drugs as Novel Delivery Systems,” Vol. 14 ofthe A.C.S. Symposium Series, and in Bioreversible Carriers in DrugDesign, ed. Edward B. Roche, American Pharmaceutical Association andPergamon Press, 1987, both of which are hereby incorporated byreference. Examples of prodrugs include pharmaceutically acceptable,non-toxic esters of the compounds of the present invention. Esters ofthe compounds of the present invention may be prepared according toconventional methods “March's Advanced Organic Chemistry, 5^(th)Edition”. M. B. Smith & J. March, John Wiley & Sons, 2001.

For parenteral administration, solutions of compounds for use accordingto the present invention in sterile aqueous solution, in aqueouspropylene glycol or in sesame or peanut oil may be employed. Aqueoussolutions should be suitably buffered where appropriate, and the liquiddiluent rendered isotonic with, e.g., sufficient saline or glucose.Aqueous solutions are particularly suitable for intravenous,intramuscular, subcutaneous and intraperitoneal administration. Thesterile aqueous media to be employed are all readily available bystandard techniques known to those skilled in the art.

Suitable pharmaceutical carriers include inert solid diluents orfillers, sterile aqueous solutions and various organic solvents.Examples of solid carriers are lactose, terra alba, sucrose,cyclodextrin, talc, gelatine, agar, pectin, acacia, magnesium stearate,stearic acid and lower alkyl ethers of cellulose. Examples of liquidcarriers are syrup, peanut oil, olive oil, phospholipids, fatty acids,fatty acid amines, polyoxyethylene and water. Moreover, the carrier ordiluent may include any sustained release material known in the art,such as glyceryl monostearate or glyceryl distearate, alone or mixedwith a wax. The pharmaceutical compositions formed by combining thecompounds for use according to the present invention and thepharmaceutically acceptable carriers are then readily administered in avariety of dosage forms suitable for the disclosed routes ofadministration. The formulations may conveniently be presented in unitdosage form by methods known in the art of pharmacy.

Formulations of the present invention suitable for oral administrationmay be presented as discrete units, such as capsules or tablets, whicheach contain a predetermined amount of the active ingredient, and whichmay include a suitable excipient.

Furthermore, the orally available formulations may be in the form of apowder or granules, a solution or suspension in an aqueous ornon-aqueous liquid, or an oil-in-water or water-in-oil liquid emulsion.

Compositions intended for oral use may be prepared according to anyknown method, and such compositions may contain one or more agentsselected from the group consisting of sweetening agents, flavouringagents, colouring agents and preserving agents in order to providepharmaceutically elegant and palatable preparations. Tablets may containthe active ingredient(s) in admixture with non-toxic pharmaceuticallyacceptable excipients which are suitable for the manufacture of tablets.These excipients may, for example, be: inert diluents, such as calciumcarbonate, sodium carbonate, lactose, calcium phosphate or sodiumphosphate; granulating and disintegrating agents, for example cornstarch or alginic acid; binding agents, for example, starch, gelatine oracacia; and lubricating agents, for example magnesium stearate, stearicacid or talc. The tablets may be uncoated or they may be coated by knowntechniques to delay disintegration and absorption in thegastrointestinal tract and thereby provide a sustained action over alonger period. For example, a time delay material such as glycerylmonostearate or glyceryl distearate may be employed. They may also becoated by the techniques described in U.S. Pat. Nos. 4,356,108;4,166,452; and 4,265,874, the contents of which are incorporated hereinby reference, to form osmotic therapeutic tablets for controlledrelease.

Formulations for oral use may also be presented as hard gelatinecapsules where the active ingredient is mixed with an inert soliddiluent, for example, calcium carbonate, calcium phosphate or kaolin, ora soft gelatine capsules wherein the active ingredient is mixed withwater or an oil medium, for example peanut oil, liquid paraffin, orolive oil. Aqueous suspensions may contain the compound for useaccording to the present invention in admixture with excipients suitablefor the manufacture of aqueous suspensions. Such excipients aresuspending agents, for example sodium carboxymethylcellulose,methylcellulose, hydroxypropylmethylcellulose, sodium alginate,polyvinylpyrrolidone, gum tragacanth and gum acacia; dispersing orwetting agents may be a naturally-occurring phosphatide such aslecithin, or condensation products of an alkylene oxide with fattyacids, for example polyoxyethylene stearate, or condensation products ofethylene oxide with long chain aliphatic alcohols, for example,heptadecaethyleneoxycetanol, or condensation products of ethylene oxidewith partial esters derived from fatty acids and a hexitol such aspolyoxyethylene sorbitol monooleate, or condensation products ofethylene oxide with partial esters derived from fatty acids and hexitolanhydrides, for example polyethylene sorbitan monooleate. The aqueoussuspensions may also contain one or more colouring agents, one or moreflavouring agents, and one or more sweetening agents, such as sucrose orsaccharin.

Oily suspensions may be formulated by suspending the active ingredientin a vegetable oil, for example arachis oil, olive oil, sesame oil orcoconut oil, or in a mineral oil such as a liquid paraffin. The oilysuspensions may contain a thickening agent, for example beeswax, hardparaffin or cetyl alcohol. Sweetening agents such as those set forthabove, and flavouring agents may be added to provide a palatable oralpreparation. These compositions may be preserved by the addition of ananti-oxidant such as ascorbic acid.

Dispersible powders and granules suitable for preparation of an aqueoussuspension by the addition of water provide the active compound inadmixture with a dispersing or wetting agent, suspending agent and oneor more preservatives. Suitable dispersing or wetting agents andsuspending agents are exemplified by those already mentioned above.Additional excipients, for example, sweetening, flavouring, andcolouring agents may also be present.

The pharmaceutical compositions comprising compounds for use accordingto the present invention may also be in the form of oil-in-wateremulsions. The oily phase may be a vegetable oil, for example, olive oilor arachis oil, or a mineral oil, for example a liquid paraffin, or amixture thereof. Suitable emulsifying agents may be naturally-occurringgums, for example gum acacia or gum tragacanth, naturally-occurringphosphatides, for example soy bean, lecithin, and esters or partialesters derived from fatty acids and hexitol anhydrides, for examplesorbitan monooleate, and condensation products of said partial esterswith ethylene oxide, for example polyoxyethylene sorbitan monooleate.The emulsions may also contain sweetening and flavouring agents.

Syrups and elixirs may be formulated with sweetening agents, for exampleglycerol, propylene glycol, sorbitol or sucrose. Such formulations mayalso contain a demulcent, a preservative and flavouring and colouringagent. The pharmaceutical compositions may be in the form of a sterileinjectable aqueous or oleaginous suspension. This suspension may beformulated according to the known methods using suitable dispersing orwetting agents and suspending agents described above. The sterileinjectable preparation may also be a sterile injectable solution orsuspension in a non-toxic parenterally-acceptable diluent or solvent,for example as a solution in 1,3-butanediol. Among the acceptablevehicles and solvents that may be employed are water, Ringer's solution,and isotonic sodium chloride solution. In addition, sterile, fixed oilsare conveniently employed as solvent or suspending medium. For thispurpose, any bland fixed oil may be employed using synthetic mono- ordiglycerides. In addition, fatty acids such as oleic acid find use inthe preparation of injectables.

The compositions may also be in the form of suppositories for rectaladministration of the compounds of the invention. These compositions canbe prepared by mixing the drug with a suitable non-irritating excipientwhich is solid at ordinary temperatures but liquid at the rectaltemperature and will thus melt in the rectum to release the drug. Suchmaterials include, for example, cocoa butter and polyethylene glycols.

For buccal and sublingual use, creams, ointments, jellies, solutions ofsuspensions, etc., containing the compounds of the invention may beemployed. In the context of the present invention, formulations forbuccal and sublingual application include mouth washes and gargles.

Compounds of the present invention may also be administered in the formof liposome delivery systems, such as small unilamellar vesicles, largeunilamellar vesicles, and multilamellar vesicles. Liposomes may beformed from a variety of phospholipids, such as cholesterol,stearylamine, or phosphatidylcholines.

In addition, some compounds of the present invention may form solvateswith water or common organic solvents. Such solvates are alsoencompassed within the scope of the invention.

Thus, a further embodiment provides a pharmaceutical compositioncomprising a compound for use according to the present invention, or apharmaceutically acceptable salt, solvate, or prodrug thereof, and oneor more pharmaceutically acceptable carriers, excipients, or diluents.

If a solid carrier is used for oral administration, the preparation maybe tabletted, placed in a hard gelatine capsule in powder or pelletform, or may be in the form of a troche or lozenge. The amount of solidcarrier will vary widely, but will usually be from about 25 mg to about1 g. If a liquid carrier is used, the preparation may be in the form ofa syrup, emulsion, soft gelatine capsule or sterile injectable liquidsuch as an aqueous or non-aqueous liquid suspension or solution.

A typical tablet that may be prepared by conventional tablettingtechniques may contain:

Core: Active compound (as free compound or 5.0 mg salt thereof) LactosumPh. Eur. 67.8 mg Cellulose, microcryst. (Avicel) 31.4 mgAmberlite ®IRP88* 1.0 mg Magnesii stearas Ph. Eur. q.s. Coating:Hydroxypropyl methylcellulose approx. 9 mg Mywacett 9-40 T** approx. 0.9mg *Polacrillin potassium NF, tablet disintegrant, Rohm and Haas.**Acylated monoglyceride used as plasticizer for film coating.

If desired, the pharmaceutical composition comprising a compoundaccording to the present invention may comprise a compound according tothe present invention in combination with further active substances,such as those described in the foregoing.

The present invention also provides methods for the preparation ofcompounds for use according to the present invention.

EXAMPLES

The potency and efficacy of the present invention can be determinedusing different pharmacological procedures. The present invention isfurther illustrated with reference to the following examples, which arenot intended to be limiting in any way to the scope of the invention asclaimed.

Example I Determination of Activation of the Serotonin 5-HT1A, 5-HT1B,5-HT1D and 5-HT1F Receptors

The [³⁵S]-GTPγS assay is used to determine the effects of the compoundsof the present invention on the serotonin 5-HT1A, 5-HT1B, 5-HT1D and5-HT1F receptors.

Membrane Preparation

Assays are performed with cells expressing the cloned human 5-HT1A,5-HT1B, 5-HT1D, 5-HT1E or 5-HT1F receptor. On the assay day, an aliquotof cells (stored at −70° C.) is thawed and re-suspended in 50 mMTris-HCl, pH 7.4, and centrifuged at 39,800 g for 10 min at 4° C. Theresulting pellet is re-suspended in 50 mM Tris-HCl, pH 7.4, incubatedfor 10 min at 37° C., and centrifuged at 39,800 g for 10 min at 4° C.

The pellet is re-suspended and centrifuged once more, with the finalpellet being suspended in 4 mM MgCl2, 160 mM NaCl, 0.267 mM EGTA, 67 mMTris-HCl, pH 7.4 for the [³⁵S]-GTPgS binding assays.

Binding Assay

The methods for the 5-HT1A, 5-HT1B, 5-HT1D, 5-HT1E or 5-HT1F receptor[³⁵S]-GTPgS binding assays are, adapted to an SPA (scintillationproximity assay) format. Incubations are performed in a total volume of200 ml in 96-well assay plates. [³⁵S]-GTPγS and guanosine-50-diphosphate(GDP) in assay buffer (MgCl₂, NaCl, EGTA in Tris-HCl, pH 7.4; 50 ml) isadded to 50 ml of test compounds diluted in water. WGA (wheat germagglutinin) beads (Amersham Pharmacia Biotech Inc., Piscataway, N.J.,USA) for SPA in assay buffer (50 ml) are then added. Membrane homogenate(50 ml) from cells expressing the cloned human 5-HT1A, 5-HT1B, 5-HT1D,5-HT1E or 5-HT1F receptor in assay buffer is added, and the plates arecovered with sealing tape (Perkin Elmer Wallac, Inc., Gaithersburg, Md.,USA) and allowed to incubate at room temperature for 2 h.

The final concentrations of MgCl₂, NaCl, EGTA, GDP, [³⁵S]-GTPγS, andTris are 3 mM, 120 mM, 0.2 mM, 10 mM, approximately 0.3 nM, and 50 mM,respectively. The plates are then centrifuged at approximately 200 g for10 min at room temperature. The amount of [³⁵S]-GTPγS bound to themembranes, i.e. in close proximity to the WGA SPA beads, is thendetermined using a Wallac MicroBeta® Trilux Scintillation Counter(Perkin Elmer Wallac, Inc.).

Data Analysis

Using GraphPad Prism software, non-linear regression analysis isperformed on the concentration-response curves (generating EC₅₀ and Emaxvalues for stimulation of [³⁵S]-GTPγS binding) using a four-parameterlogistic equation. Efficacy (Emax) values, determined by the non-linearregression analysis, for the selected compounds, is expressed as thepercentage of [³⁵S]-GTPγS binding relative to the response produced by10 mM of agonists for the (5-HT1A, 5-HT1B, 5-HT1E or 5-HT1F receptors or1 mM 5-HT agonist for the 5-HT1D receptor which is run as a standardwith each concentration-response curve.

Example II Evaluation of 5-HT1 Agonists for Treatment of MovementDisorders Associated with Parkinson's Disease and LID The 6-OHDA RatModel

6-OHDA (6-hydroxydopamine) is a neurotoxin that selectively killsdopaminergic and noradrenergic neurons and induces a reduction ofdopamine levels in the brain. Administration of L-DOPA to unilaterally6-OHDA-lesioned rats induces abnormal involuntary movements (AIMs).These are axial, limb and oral movements that occur only on the bodyside that is ipsilateral to the lesion. AIM rat models have been shownuseful because they respond to a number of drugs which have been shownto suppress dyskinesia (including PD) in humans.

The 6-OHDA rat model is also useful for studying other movementdisorders associated with Parkinson's disease, such as akinesia anddecreased motor performance and coordination.

Test Procedure:

Animals: 90 experimentally-naïve, male, Sprague-Dawley rats at bodyweight of 200 to 250 g from Shanghai SLAC Co. Ltd. arrive at thelaboratory at least 1 week prior to behavioural testing. Rats are housedin groups of n=2/cage. Animals have ad libitum access to standard rodentchow and water. Animal housing and testing rooms are maintained undercontrolled environmental conditions and are within close proximity ofeach other. Animal housing rooms are on a 12-hour light-dark cycle withlights on at 6:00 AM and maintained at 70° F./21° C. (range: 68-72°F./20-22° C.) with a humidity range of 20-40%. Testing rooms aremaintained at 68-72° F. with a humidity range of 20-40%.

6-OHDA Lesion Surgery:

DA-denervating lesions are performed by unilateral injection of 6-OHDAin the ascending nigrostriatal pathway. Rats were anesthetized withpentobarbital sodium 40 mg/kg (i.p.) and positioned in a stereotacticframe. 6-OHDA is injected into the right ascending DA bundle at thefollowing coordinates (in mm) relative to bregma and dural surface: (1)toothbar position −2.3, A=−4.4, L=1.2, V=7.8, (7.5 ug 6-OHDA), (2)toothbar position +3.4, A=−4.0, L=0.8, V=8.0 mm (6 ug 6-OHDA). Theneurotoxin injections are performed at a rate of 1 ul/min, and theinjection cannula is left in place for an additional 2-3 min thereafter.Two weeks after surgery rats with nearly complete (>90%) lesions areselected by means of an amphetamine-induced rotation test. The animalsare placed in plastic Perspex bowls (30 cm in diameter) and therotational behavior (360° turns) is recorded by an automated rotometerfor 90 min after the i.p. injection of 2.5 mg/kg d-amphetamine sulphate.Animals exhibiting 56 full body turns/min towards the side of DAdeficiency are included in the study. Animals are then allocated intotwo well-matched sub-groups (according to the amphetamine rotation) andreceive daily treatment as described below.

Drugs and Treatment Regimens Drug Treatment:

L-DOPA methyl ester (Sigma-Aldrich, Germany) is given at the dose of 6mg/kg/day, combined with 15 mg/kg/day of benserazide HCl (Sigma-Aldrich,Germany). Chronic treatment with this dose of L-DOPA and benserazide isgiven for 3 weeks to all the rats with good lesions in order to induce agradual development of dyskinetic-like movements. Thereafter, rats thathave not developed dyskinesia are excluded from the study, and the ratswith a cumulative AIM score ≧28 points over five testing sessions(dyskinesia severity ≧grade 2 on each axial, limb and orolingual scores)are kept on a drug treatment regimen of at least two injections ofL-DOPA/benserazide per week in order to maintain stable AIM scores. Theselected rats are allocated groups of 9-12 animals each, which arebalanced with the respect to AIM severity. The animals are then treatedwith the drug and drug combinations as described below.

Prevention:

In the prevention study rats are treated with L-DOPA methyl ester (6mg/kg i.p. plus benserazide 15 mg/kg) in combination with buspirone(0.5-10 mg/kg/day) and zolmitriptan (0.5 mg/kg/day-20 mg/kg/day i.p.)given at the same time of L-DOPA, for 3 weeks. At the end of thistreatment (treatment period 1), animals received a low dose ofapomorphine (0.02 mg/kg, s.c.) and tested for apomorphine-induced AIMsin order to investigate the sensitization state of the DA receptors.Treatments are then continued so that animals are treated only withL-DOPA for an additional two weeks (treatment period 2). Animals areinjected daily and tested every second day for L-DOPA-induced dyskinesiathroughout the experimental periods 1 and 2 and then sacrificed for HPLCanalysis of DA, serotonin and metabolites.

L-DOPA Induced AIMs and Drugs Screening Test

AIMs ratings are performed by an investigator who was kept unaware ofthe pharmacological treatment administered to each rat (experimentallyblinded). In order to quantify the severity of the AIMs, rats areobserved individually in their standard cages every 20th minute at20-180 min after an injection of I-DOPA. The AIM's are classified intofour subtypes:

(A) axial AIMs, i.e., dystonic or choreiform torsion of the trunk andneck towards the side contralateral to the lesion. In the mild cases:lateral flexion of the neck or torsional movements of the upper trunktowards the side contralateral to the lesion. With repeated injection ofL-DOPA, this movement may develop into a pronounced and continuousdystonia-like axial torsion.(B) limb AIMs, i.e., jerky and/or dystonic movements of the forelimbcontralateral to the lesion. In mild cases: hyperkinetic, jerky steppingmovements of the forelimb contralateral to the lesion, or small circularmovements of the forelimb to and from the snout. As the severity ofdyskinesia increases (which usually occurs with repeated administrationof L-DOPA), the abnormal movements increase in amplitude, and assumemixed dystonic and hyperkinetic features. Dystonic movements are causedby sustained co-contraction of agonist/antagonist muscles; they are slowand force a body segment into unnatural positions. Hyperkineticmovements are fast and irregular in speed and direction. Sometimes theforelimb does not show jerky movements but becomes engaged in acontinuous dystonic posture, which is also scored according to the timeduring which it is expressed.(C) orolingual AIMs, i.e., twitching of orofacial muscles, and bursts ofempty masticatory movements with protrusion of the tongue towards theside contralateral to the lesion. This form of dyskinesia affectsfacial, tongue, and masticatory muscles. It is recognizable as bursts ofempty masticatory movements, accompanied to a variable degree by jawopening, lateral translocations of the jaw, twitching of facial muscles,and protrusion of the tongue towards the side contralateral to thelesion. At its extreme severity, this subtype of dyskinesia engages allthe above muscle groups with notable strength, and may also becomecomplicated by self-mutilative biting on the skin of the forelimbcontralateral to the lesion (easily recognizable by the fact that around spot of skin becomes devoid of fur.(D) locomotive AIMs, i.e., increased locomotion with contralateral sidebias. The latter AIM subtype was recorded in conformity with theoriginal description of the rat AIM scale, although it was laterestablished that locomotive AIMs do not provide a specific measure ofdyskinesia, but rather provide a correlate of contralateral turningbehaviour in rodents with unilateral 6-OHDA lesions. Each of the foursubtypes are scored on a severity scale from 0 to 4, where 0=absent,1=present during less than half of the observation time, 2=present formore than half of the observation time, 3=present all the time butsuppressible by external stimuli, and 4=present all the time and notsuppressible by external stimuli. Axial, limb and orolingual AIMs arefound to be modulated in a similar way by all the tested substances.Therefore, scores from these three AIM subtypes are summed. The sum ofeither locomotive axial, limb, and orolingual or axial, limb, andorolingual AIM scores per testing session are used for statisticalanalyses.

The results of the drug screening test show that buspirone (1 mg/kg/dayi.p.) in combination with zolmitriptan (1 mg/kg/day i.p. or 5 mg/kg/day)significantly reduces L-DOPA-induced dyskinesia.

Below are a number of test which have the purpose of testing thecompounds for side effects, such as reduced motor performance:

As mentioned above 6-OHDA-lesioned rats can also be used for as a modelfor other movement disorders associated with Parkinson's disease, suchas bradykinesia, akinesia and decreased motor performance andcoordination in these rats. Treatment with L-DOPA has beneficial effectson these movement disorders induced in the 6-OHDA-lesioned rats forexample by preventing or reducing akinesia. It is of interest to testwhether the combinations of compounds of the present invention havenegative effects or impair the ability of L-DOPA to improve akinesia,decreased motor performance and coordination.

Rotarod Test

The rotarod test is performed after the administration of L-DOPA plusthe doses of buspirone and zolmitriptan under investigation, or L-DOPAplus vehicle, using the same crossover design that was applied in theAIMs ratings sessions. The rotarod test serves the purpose of detectingpotential deleterious effects of the compounds studied on the rats'motor performance and coordination. The rotarod test is performed usinga previously described protocol (e.g. Dekundy et al: Behavioural BrainResearch 179 (2007) 76-89). In brief, the animals are placed on theaccelerating rod apparatus at an initial speed of 4 rotations per minute(rpm), with the speed increasing gradually and automatically to 40 rpmover 300 s. The animals are pre-trained to reach a stable performance inthis test before initiating the drug screening studies. The trainingconsisted of three sessions on 3 consecutive days, and each sessionincluded two separate testing trials. Between the testing sessions, theanimals are given a shorter “motivational session” where the rod speedis increased from 4 to 14 rpm of 25 s only. Animals can stay on the rodfor the entire 25 s in these low-speed sessions, which has been shown tohave a positive effect on the animals' willingness to perform in thistest. To maintain the alertness of the animals during all the testingsessions, the animals are tapped on their tails several times by theexperimenter. In the drug-screening experiments, the animals are placedon the rod at 45-60 min interval after L-DOPA administration (i.e., atthe time when central levels of L-DOPA reach their peak. The rotarodperformance is expressed as total number of seconds spent on theaccelerating rod. Buspirone (1 mg/kg/day i.p.) in combination withzolmitriptan (1 mg/kg/day i.p. or 5 mg/kg/day i.p.) only have limitedeffects on performance in the rotarod model, when compared to the ratstreated only with L-DOPA (i.e. the performance was the similar), showingthat motor performance and coordination is not significantly reduced inrats after administration of the compounds, and that in the rotarod testthe combination of buspirone (1 mg/kg/day i.p.) in combination withzolmitriptan (1 mg/kg/day i.p. or 5 mg/kg/day i.p.) does not impair theability of L-DOPA to improve motor function.

Activity Test

Locomotor activity is assessed (at day 3 of the treatment period 1) inopen-field chambers, each equipped with a 16×16 infrared photobeamsystem (dimensions 40.6 cm×40.6 cm×38.1 cm) using the Flex-FieldSoftware system (San Diego Instruments, San Diego, Calif.). Animals arehabituated for 1 h before buspirone and zolmitriptan in the dosesinvestigated drugs are injected and the measurements are started.

Effects on Parkinson's Disease Stepping Test:

The stepping test (Schallert et al., 1992) is performed as described byKirik et al., 2001 with little modifications. Briefly, the rat is heldby the experimenter fixing its hindlimbs with one hand and the forelimbnot to be monitored with the other, while the unrestrained forepaw istouching the table. The number of adjusting steps is counted, while therat is moved sideways along the table surface (90 cm in 5 s), in theforehand and backhand direction, for both forelimbs, and the average ofthe steps in the two directions is considered. Performance of theanimals in the stepping test is assessed during treatment period 1(after training sessions and reach of a stable performance) in theL-DOPA, buspirone and zolmitriptan-treated group and in a group of naiverats, after administration of L-DOPA, buspirone and zolmitriptan+ orL-DOPA only, respectively. On the day of the test (day 5 of treatmentperiod 1) L-DOPA, buspirone and zolmitriptan-treated and naive rats aretested twice in baseline condition and two more times 60 min afteradministration of the drugs. Values are reported as an average of thetwo sessions on and off drug. The results show that buspirone (1mg/kg/day i.p.) in combination with zolmitriptan (1 mg/kg/day i.p. or 5mg/kg/day) (which significantly reduce L-DOPA-induced dyskinesia) do nothave significant negative effects on the treatment with L-DOPA in thismodel, when comparing rats treated with L-DOPA alone to rats treatedwith both L-DOPA and a combination of buspirone and zolmitriptan. Thus,the combination of buspirone (1 mg/kg/day i.p.) in combination withzolmitriptan (1 mg/kg/day i.p. or 5 mg/kg/day i.p.) does not impair theability of L-DOPA to improve motor function.

Tacrine-Induced Tremulous Jaw Movements in Rats can be Used as anExperimental Model of Parkinsonian Tremor

Observations of tremulous jaw movements in rats are made in a 27×17.5×17cm clear plexiglas chamber with a wire mesh floor. Tremulous jawmovements are defined as rapid vertical deflections of the lower jawthat resemble chewing but are not directed at any particular stimulus.Each individual deflection of the jaw is recorded using a mechanicalhand counter. Jaw movements are recorded by an observer who is unawareof the experimental treatment conditions, and the observer is trained todemonstrate inter-rater reliability with a second observer over a numberof pilot test sessions (r=0.92; P <0.05). To induce tremulous jawmovements, each rat receives an i.p. injection of 5.0 mg/kg of theanticholinesterase tacrine 10 min before testing. Rats are placed in theobservation chamber immediately after tacrine injection for a 10-minhabituation period. The rats are subsequently observed for tremulous jawmovements during a 5-min session. The effects of buspirone incombination with zolmitriptan, 20 min before tacrine; n=11) ontacrine-induced tremulous jaw movements are evaluated. Rats are testedonce a week for 5 weeks, during the light phase of the light/dark cycle.Over the course of the experiment, each rat receives all treatments in arandomly varied order. Vehicle levels of tremulous jaw movement activityare consistent across the repeated weeks of the study. The studies showthat buspirone (1 mg/kg/day i.p.) in combination with zolmitriptan (1mg/kg/day i.p. or 5 mg/kg/day) (which significantly reduceL-DOPA-induced dyskinesia), do not have negative effects on thetreatment with L-DOPA in this model, when comparing rats treated withL-DOPA alone to rats treated with both L-DOPA and a combination ofbuspirone and zolmitriptan.

In conclusion, the combination of buspirone (1 mg/kg/day i.p.) withzolmitriptan (1 mg/kg/day i.p. or 5 mg/kg/day) gives no significantreduction in motor performance and coordination of the rat in therotarod, stepping, or tremulous-jaw test mentioned above. Furthermore,the combination of buspirone (1 mg/kg/day i.p.) with zolmitriptan (1mg/kg/day i.p. or 5 mg/kg/day i.p.) does not impair the beneficialeffects of L-DOPA on motor performance in models of Parkinson's disease.Together this demonstrates that a combination of buspirone andzolmitriptan in doses that reduces LID (L-DOPA induced dyskinesia) in asubject, will not impair the ability of L-DOPA to reduce symptoms ofParkinson's disease, such as akinesia.

In Vivo Microdialysis and Behavior

Administration of L-DOPA to unilaterally 6-OHDA-lesioned rats inducesabnormal involuntary movements (AIMs) and changes in concentrations ofneurotransmitters in the brain. Using special methodologies it ispossible to measure levels of such neurotransmitters (e.g. dopamine,gamma amino butyric acid (GABA), noradrenalin, serotonin) in differentbrain regions in freely moving rats that previously have been treatedwith 6-OHDA. This procedure allows for a direct comparison betweencentral neurotransmitters and behavior and is a method used to determinemechanism of action and efficacy of compounds of the present invention.

Buspirone (1 mg/kg/day i.p.) in combination with zolmitriptan (1mg/kg/day i.p. or 5 mg/kg/day) are shown to significantly reduce centraldopamine levels as determined by this method.

PET Scanning.

The levels of neurotransmitters and receptors for such neurotransmittersin different regions of the brain of animals and humans can bedetermined using PET scanning. Such procedures are useful to studylevels of dopamine and dopamine receptors in healthy and disease animalsand humans and thereby study effects of drug treatment of Parkinson'sdisease. Furthermore this procedure can be used to predict effects inhumans from animal studies and are useful for predicting efficacy ofdrug combinations of the current invention. A commonly used PET tracerfor studying dopamine levels in human volunteers, in patients sufferingfrom Parkinson's disease and in animal models of Parkinson's disease is[¹¹C]raclopride. Raclopride is a ligand for the dopamine D2 and D3receptors. Using PET scanning, this tracer allows for a determination ofchanges in extracellular dopamine levels caused by treatment with drugsand drug combinations.

The experimental setup testing various doses of buspirone (0.5-20 mg/dayi.p.) in combination with various doses of zolmitriptan (0.5-20 mg/dayi.p.) shows that buspirone (1 mg/kg/day i.p.) in combination withzolmitriptan (1 mg/kg/day i.p. or 5 mg/kg/day) significantly reducescentral dopamine levels as determined by this method.

Example III Treatment of Individuals Suffering from Movement Disorders

The following illustrates an example of the use of the compounds of theinvention for treatment of patient suffering from LID:

A 69 years old woman has been diagnosed with PD 6 years ago and hassince then been treated with L-DOPA/carbidopa (300/75 mg given in 3divided doses). She has started to experience involuntary movements andis diagnosed with L-DOPA induced dyskinesia. The patient is treated witha combination of buspirone (20 mg) and zolmitriptan (2.5 mg)administered orally two times a day. After 8 days of treatment, thesymptoms of dyskinesia are assessed by the scales Lang-Fahn Activitiesof Daily Living Dyskinesia scale, Clinical Global Impression, UnifiedParkinson's Disease Rating Scales as well as the Abnormal InvoluntaryMovement Scale (AIMS). The patient is continuously administeredbuspirone and zolmitriptan in the doses mentioned above.

The following illustrates an example of the use of the compounds of theinvention for treatment of patient suffering from neuroleptica inducedakathisia:

A 28-year-old male with schizophreniform disorder has developedakathisia following 4 days of treatment with haloperidol 10 mg/day.Akathisia is rated as 4 (marked) using the Barnes Akathisia Scale (BAS).The BAS is a validated, clinician-administered scale used to evaluatethe severity of drug-induced akathisia. The patient is treated with acombination of buspirone (20 mg) and zolmitriptan (2.5 mg) administeredorally two times a day. After 14 days of treatment, the BAS score isobserved in order to detect changes in the akathisia related symptoms.

The following illustrates an example of the use of the compounds of theinvention for treatment of patient suffering from neuroleptica inducedtardive dyskinesia.

A 19 year old woman with a 12 month history of schizophrenia, developedbuccolingual masticatory tardive dyskinesia (assessed with the AbnormalInvoluntary Movement Scale (AIMS)) after receiving risperidone 6 mg. Thepatient is treated with a combination of buspirone (20 mg) andfrovatriptan (1 mg) administered orally two times a day. After 3 weeksof treatment improvement in the tardive dyskinesia is assessed.

Example IV Evaluation of 5-HT1 Agonists Buspirone and Zolmitriptan forTreatment of Movement Disorders Associated with Parkinson's Disease andLID

The present study describes the evaluation of zolmitriptan and buspironein the 6-OHDA rat model as described in Example II.

Test Procedure:

Animals: 98 Sprague-Dawley male rat (bred in house, originally from SLACLaboratory Animal Co. Ltd) at 9-week of age at body weight of 200 to 250g from Shanghai SLAC Co. Ltd. arrived at the laboratory at least 1 weekprior to behavioural testing. Rats were housed in groups of n=2/cage.Animals had ad libitum access to standard rodent chow and water. Animalhousing and testing rooms were maintained under controlled environmentalconditions and were within close proximity of each other. Animal housingrooms were on a 12-hour light-dark cycle with lights on at 6:00 AM andmaintained at 70° F./21° C. (range: 68-72° F./20-22° C.) with a humidityrange of 20-40%. Testing rooms were maintained at 68-72° F. with ahumidity range of 20-40%.

6-OHDA Lesion Surgery:

Dopamine (DA)-denervating lesions were performed by unilateral injectionof 6-OHDA in the ascending nigrostriatal pathway. Rats were anesthetizedwith pentobarbital sodium 40 mg/kg (i.p.) and positioned in astereotactic frame. 6-OHDA was injected into the right ascending DAbundle at the following coordinates (in mm) relative to bregma and duralsurface: (1) toothbar position −2.3, A=−4.4, L=1.2, V=7.8, (7.5 ug6-OHDA), (2) toothbar position +3.4, A=−4.0, L=0.8, V=8.0 mm (6 ug6-OHDA). Alternatively only one injection was made with the followingcoordinates: Tooth bar: −3.3 mm, AP: −1.8 mm, ML: −2.0 mm, DV: −8.6 mm(18 μg/6 μg/6-OHDA). The neurotoxin injections were performed at a rateof 1 ul/min, and the injection cannula was left in place for anadditional 2-3 min thereafter.

After recovery from surgery, rats with nearly complete (>90%) lesionswere selected by means of an apomorphin-induced rotation test. I.p.injection of 0.5 mg/kg apomorphine.HCl (Sigma) in saline evokedcontralateral turning, which is considered to be the result ofde-nervated hypersensitivity of DA receptors in the lesion side.Rotational behaviour in response to DA agonists grossly correlates withthe severity of the lesion. Quantification of the rotational responsewas accomplished in rats by counting the turns in 30 minutes. Rat withrotational score turns/min were selected for next tests. Animals werethen allocated into two well-matched sub-groups (according to theamphetamine rotation) and received daily treatment as described below.

Drugs and Treatment Regimens

L-DOPA methyl ester (Sigma, Cat No. D9628 Lot. No. 030M1604V)) was givenat the dose of 6 mg/kg/day, combined with 15 mg/kg/day of benserazideHCl. Chronic treatment with this dose of L-DOPA and benserazide wasgiven for 3 weeks or more to all the rats with good lesions in order toinduce a gradual development of dyskinetic-like movements. Thereafter,rats that had not developed dyskinesia were excluded from the study, andthe rats with a cumulative AIM score points over five testing sessions(dyskinesia severity grade 2 on each axial, limb and orolingual scores)were kept on a drug treatment regimen of at least two injections ofL-DOPA/benserazide per week in order to maintain stable AIM scores. Theselected rats were allocated groups of 9-12 animals each, which werebalanced with the respect to AIM severity. The animals were then treatedwith the drug and drug combinations as described below.

L-DOPA Induced AIMs and Drugs Screening Test

Rats were tested for AIMs as described above in Example II except thatthe sum of locomotive (LO) or axial (AX), limb (LI), and orolingual (OL)AIM scores per testing session was used for statistical analyses.

To determine the effects of specific doses of a combination of buspironeand zolmitriptan the following group setting was used:

Vehicle: (saline, i.p., 30 min before L-DOPA, n=6)Buspirone (1 mg/kg, i.p., n=6)Zolmitriptan (From Damas-beta, Cat. No. TSP76106 Lot. No. T4903TSP76106,10 mg/kg, i.p. n=6)Zolmitriptan (3 mg/kg, i.p.)+Buspirone (1 mg/kg, i.p., n=6)Zolmitriptan (10 mg/kg, i.p.)+Buspirone (1 mg/kg, i.p., n=6)Zolmitriptan is given 35 minutes before L-DOPA while buspirone is given30 minutes before L-DOPA.

The results of the drug screening test are presented in FIG. 1 andshowed that buspirone (1 mg/kg/day i.p.) in combination withzolmitriptan (3 mg/kg/day i.p. or 10 mg/kg/day) significantly reducedL-DOPA-induced dyskinesia. When given alone zolmitriptan (10 mg/kg/day)did not reduce AIM, while buspirone (1 mg/kg/day i.p.) only partlyreduced AIM.

Example V

The present study describes the evaluation of zolmitriptan and buspironein the 6-OHDA rat model in a study using the rotarod test. Using thisstudy, a treatment with combination of compounds according to thepresent invention can be evaluated for their sedative effects, and/ortheir effects on the motor performance compared to sedated rats and torats which only had saline injections.

Rotarod Test

The rotarod test serves the purpose of detecting potential deleteriouseffects of the compounds studied on the rats' motor performance andcoordination. In brief, the animals (30 SD male rats (180-220 g, bred inhouse, originally from SLAC Laboratory Animal Co. Ltd) at 9-week of age)were trained twice a day for a 3-day period. The rats were placed on theaccelerating rod apparatus (Shanghai Jiliang, China) at an initial speedof 4 rotations per minute (rpm), with the speed increasing gradually andautomatically to 40 rpm over 300s. Each training trial was ended if theanimal fell off or grips the device and spun around for two consecutiverevolutions. The time that rat stayed on the Rotarod was recorded. Thestaying duration recorded at last training trail was used as baseline.Rats were grouped according a randomly distribution of baseline.

For the test session on the fourth day, the rats were evaluated on theRotarod with the same setting as above at 30 min after dosing. The ratswere dosed with drugs as described below. Dosing and Rotarod measurementwere conducted by two scientists separately. Pentobarbital (15 mg/kg.i.p.) was used a as a positive control.

Group Setting for Compound Tests:

Vehicle: Saline, i.p., 30 min before test, n=10Positive control: Pentobarbital 15 mg/kg, i.p. 30 min before test, n=10

Combination:

Zolmitriptan 3 mg/kg, i.p. 5 min before buspironeBuspirone 1 mg/kg, i.p. 30 min before test, n=10

Statistical analysis: The rotarod performance is expressed as totalnumber of seconds spent on the accelerating rod. The data were analyzedusing One-Way ANOVA and the Tukey post-hoc test.

Result:

See FIG. 2.

Buspirone (1 mg/kg/day i.p.) in combination with zolmitriptan (3mg/kg/day i.p.) had no statistically significant effects on performancein the rotarod model compared to rats injected with vehicle only,showing that motor performance and coordination is not significantlyreduced in rats after administration of the compounds. In comparisonpentobarbital significantly reduced time spend on the rotarod.

Example VI

The present study describes the evaluation of zolmitriptan and buspironein the 6-OHDA rat model. Using this study, a treatment with combinationof compounds according to the present invention can be evaluated fortheir sedative effects, and/or their effects on the motor performancecompared to sedated rats and to rats which only had saline injections.

Open Field Test

The open field test was used to determine the effects of drug onlocomotor activity. Rats were put in open-field chambers (dimensions 40cm×40 cm) 30 minutes after dosing. After a 15 minutes habituation,locomotion were recorded and analysed by Enthovision Video TrackingSoftware (Noldus Information Technology, Netherlands) for 60 minutes.All locomotor activities were done during dark phase and to eliminateolfactory cues, the arena was thoroughly cleaned with 70% v/v ethanolbetween each test.

Group Setting for Compound Tests:

Vehicle: Saline, i.p., 30 min before test, n=10Positive control: Pentobarbital 15 mg/kg, i.p. 30 min before test, n=10

Combination:

Zolmitriptan 3 mg/kg, i.p. 5 min before buspironeBuspirone 1 mg/kg, i.p. 30 min before test, n=10

Statistical analysis: The total locomotor activity is expressed as totalmoved distance (cm) and average velocity (cm/s) during 60 minutes. Thedata were analysed using One-Way ANOVA and the Tukey post-hoc test. Thelocomotor activity in six time point is expressed as moved distance (cm)and average velocity (cm/s) every 10 minutes. The data were analysedusing One-Way ANOVA and the Tukey post-hoc test in each time point.

Result:

See FIG. 3.

A treatment with buspirone (1 mg/kg/day i.p.) in combination withzolmitriptan (3 mg/kg/day i.p.) had no statistically significant effectson performance in the open field test compared to rats injected withvehicle only as measured during the 30 minutes observation period.Pentobarbital significantly reduced motor performance during the totalobservation period.

Example VII L-DOPA Induced AIMs and Drugs Screening Test

Rats were tested for AIMs as described above in Example II except thatthe sum of locomotive (LO) oraxial (AX), limb (LI), and orolingual (OL)AIM scores per testing session was used for statistical analyses. Todetermine the effects of specific doses of a combination of buspironeand zolmitriptan the following group setting was used:

Vehicle: (saline, i.p., 30 min before L-DOPA, n=6)Buspirone (0.5 mg/kg, intra peritoneally (i.p.), n=6)Buspirone (0.5 mg/kg i.p.)+Zolmitriptan (From Damas-beta, Cat. No.TSP76106 Lot. No. T4903TSP76106, 3 mg/kg i.p.)Buspirone (0.5 mg/kg i.p.)+Zolmitriptan (10 mg/kg i.p.)Buspirone (1 mg/kg i.p.)+Zolmitriptan (10 mg/kg i.p.)Zolmitriptan was given 35 minutes before L-DOPA while buspirone wasgiven 30 minutes before L-DOPA.

The results of the drug screening test are presented in FIG. 4 andshowed that buspirone (0.5 mg/kg i.p.) in combination with zolmitriptan(3 mg/kg i.p. or 10 mg/kg i.p) or buspirone (1.0 mg/kg i.p.) incombination with zolmitriptan (10 mg/kg i.p) significantly reducedL-DOPA-induced dyskinesia. When given alone buspirone (0.5 mg/kg i.p.)only partly reduced AIM.

Example VIII Forepaw Adjusting Steps (FAS)

The FAS test (Schallert et al., 1992, Olsson et al., J Neurosci;15:3863-75, 1995) has been extensively utilized as a measure of forelimbakinesia, demonstrating sensitivity to DA loss and reversal of deficitby DA replacement therapy.

Test Procedure:

Animals: 60 Sprague-Dawley male rats (290 g-340 g, bought from. SLACLaboratory Animal Co. Ltd at an age of 8-10 weeks). Rats were housed ingroups of n=2/cage. Animals had ad libitum access to standard rodentchow and water. Animal housing and testing rooms were maintained undercontrolled environmental conditions and were within close proximity ofeach other. Animal housing rooms were on a 12-hour light-dark cycle withlights on at 6:00 AM and maintained at 70° F./21° C. (range: 68-72°F./20-22° C.) with a humidity range of 20-40%. Testing rooms weremaintained at 68-72° F. with a humidity range of 20-40%.

6-OHDA Lesion Surgery:

Dopamine (DA)-denervating lesions were performed by unilateral injectionof 6-OHDA in the median forebrain bundle containing the ascendingnigrostraital pathway. Rats were anesthetized with pentobarbital sodium40 mg/kg (i.p.) and positioned in a stereotactic frame. 6-OHDA wasinjected at the following coordinates (in mm) relative to bregma anddural surface: Tooth bar: −3.3 mm, AP: −1.8 mm, ML: −2.0 mm, DV: −8.6 mm(18 μg/6 μl 6-OHDA). The neurotoxin injections were performed at a rateof 0.5 μl/min, and the injection cannula was left in place for anadditional 2-3 min thereafter.

After recovery from surgery, rats with nearly complete (>90%) lesionswere selected by means of an apomorphin-induced rotation test. I.p.injection of 0.5 mg/kg apomorphine.HCl (Sigma) in saline evokedcontralateral turning, which is considered to be the result ofhypersensitivity of DA receptors in the lesion side. Rotationalbehaviour in response to DA agonists grossly correlates with theseverity of the lesion. Quantification of the rotational response wasaccomplished in rats by counting the turns in 30 minutes. Rats withrotational counts ≧180 turns in 30 minutes were elected for next tests.Animals were then allocated into two well-matched sub-groups (accordingto the apomorphine rotation) and received daily treatment with L-DOPA.

Drugs and Treatment Regimens

The 6-OHDA unilateral lesion model rats (600 g-630 g, 25-week of age,husbandried in house) were used in the study.

Initially baseline was established by the following procedure. All thetest animals were habituated by the experimenter to grip. The rat wastrained to run spontaneously up the ramp to the home cage with itsungriped paw. Adjusting steps of each rat were consisted of moving intwo directions (forehand and backhand).

Each baseline adjusting step test consisted of two subtests of the dayand the mean of the two subtests were calculated as baseline.

Forty animals, which had the baseline test in the model, were used inthe combination study with zolmitriptan (Damas-beta, Cat No. TSP76106,Lot. No. T4903TSP76106), buspirone (Sigma, Cat. No. B7148, Lot. No.042K1763Z) and L-DOPA (Sigma, Cat No. D9628, Lot. No. 030M1604V. L-DOPAand benzerazide was dissolved in saline (vehicle 1) while buspirone andzolmitriptan were dissolved in 10% tween-80 (vehicle 2).

Group Setting for Compound Tests:

1) Vehicle 1 (saline) with 15 mg/kg benserazide HCl (s.c. 60 minpretest)+Vehicle 2 (10% tween-80, i.p., 30 min pretest)+Vehicle 2 (10%tween-80, i.p., 30 min pretest, n=14).2) L-DOPA 3 mg/kg with 15 mg/kg benserazide HCl (s.c. 60 minpretest,)+Vehicle 2 (10% tween-80, i.p., 30 min pretest)+Vehicle 2 (10%tween-80, i.p., 30 min pretest, n=14).3) L-DOPA 3 mg/kg with 15 mg/kg benserazide (s.c. 60 min pretest)+0.5mg/kg buspirone (i.p., 30 min pretest)+10 mg/kg zolmitriptan (i.p., 30min pretest, n=14)

The test rats were allocated randomly to 3 groups, which were balancedwith the respect to the baseline test.

All the test animals were habituated by the experimenter to grip. Therat was trained to run spontaneously up the ramp to the home cage withits ungriped paw.

Adjusting steps of each rat were consisted of moving in two directions(forehand and backhand).

Each baseline adjusting step test consisted of two subtests of the dayand the mean of the two subtests were calculated as baseline.

Data was presented as percentage of adjusting step of impaired paw tointact paw. This calculation indicates the degree of forepaw disability.

It was found that acute treatment of 3 mg/kg L-DOPA (with 15 mg/kgbenserazide) alleviated 6-OHDA induced akinesia by increasing theforelimb use. An acute co-administration of buspirone (0.5mg/kg)+zolmitriptan (10 mg/kg) did not change the effect of L-DOPA (3mg/kg with 15 mg/kg benserazide) on 6-OHDA induced akinesia.

The average percentage of adjusting steps in each groups were calculatedas: Vehicle: 64.4%

L-DOPA (3 mg/kg with 15 mg/kg benserazide): 77.8%L-DOPA (3 mg/kg with 15 mg/kg benserazide) plus buspirone (0.5mg/kg)+zolmitriptan (10 mg/kg): 77.9%

To study the effects of a combination of buspirone (0.5mg/kg)+zolmitriptan (10 mg/kg) without co-administration of L-DOPA thefollowing groups were examined:

1) Vehicle 1 with 15 mg/kg benserazide HCl (s.c., 60 minpretest)+Vehicle 2, (i.p., 30 min pretest)+Vehicle 2 (i.p., 30 minpretest, n=10).2) 3 mg/kg L-DOPA with 15 mg/kg benserazide HCl (s.c., 60 minpretest)+Vehicle 2 (i.p., 30 min pretest)+Vehicle 2 (30 min pretest,n=10). n=10).3) Vehicle 1 with 15 mg/kg benserazide (s.c. 60 min pretest)+0.5 mg/kgbuspirone (i.p., 30 min pretest)+10 mg/kg zolmitriptan (i.p., 30 minpretest, n=10).

It was found that 3 mg/kg L-DOPA with 15 mg/kg benserazide HClsignificantly increase the forelimb use. The effect of buspirone (0.5mg/kg)+zolmitriptan (10 mg/kg) on forelimb use was not significantlydifferent from L-DOPA.

The average percentage of adjusting steps in each groups were calculatedas:

Vehicle: 69.5%

L-DOPA (3 mg/kg with 15 mg/kg benserazide): 77.7%Buspirone (0.5 mg/kg)+zolmitriptan (10 mg/kg): 82.0%

The results show that a combination of buspirone and zolmitriptan indoses that are able to reduce abnormal involuntary movements in a ratmodel of L-DOPA induced dyskinesia do not impair the effects of L-DOPAon akinesia.

This further demonstrates that a combination of buspirone andzolmitriptan could reduce L-DOPA induced dyskinesia in patientssuffering from Parkinson's disease without affecting the beneficialeffects of L-DOPA. Furthermore that data demonstrate that combination ofbuspirone and zolmitriptan alone has a beneficial effect on symptoms ofParkinson's disease.

Example IX Effects of Compounds in Rat Model of Tardive Dyskinesia

Zolmitriptan given in combination with buspirone, was evaluated forpossible activity against reserpine-induced tardive dyskinesia in mice.Reserpine at 1 mg/kg was injected subcutaneously (s.c.) to inducetardive dyskinesia on days 1 and 3. Combinations of zolmitriptan withbuspirone were given intraperitoneally (i.p.) 24 hours following the 2ndreserpine injection. VCM (vacuous chewing movements) were measured for10 minutes, 1 hour after the 2nd injection of test compounds on day 4.Buspirone and zolmitriptan dissolved/suspended in 20% Tween 20/0.9% NaClwere administered intraperitoneally with a dosing volume of 10 mL/kg.All the test substances were prepared freshly before use.

Male ICR mice weighing 36±2 g were obtained from BioLasco Taiwan, aCharles River Laboratories Technology Licensee. The animals were housedin animal cages with a space allocation of 29×8×13 cm for 5 mice. Allanimals were maintained in a hygienic environment under controlledtemperature (20° C.-24° C.), humidity (50%-80%) with 12 hours light/darkcycles for at least three days prior to use in Ricerca Taiwan, Ltd.laboratory. Free access to standard lab chow [MF-18 (Oriental Yeast Co.,Ltd., Japan)] and tap water was granted. All aspects of this workincluding housing, experimentation and disposal of animals wereperformed in general accordance with the Guide for the Care and Use ofLaboratory Animals (National Academy Press, Washington, D. C., 1996).

Groups of 10 male ICR mice weighing 36±2 g (at arrival) were used. Allanimals were challenge with 1st dose of reserpine (1 mg/kg s.c.) on day1, followed by 2nd dosing of reserpine separated by 48 hours on day 3 toinduce tardive dyskinesia. Vehicle and test articles were injectedintraperitoneally 24 hours post the 2nd challenge of reserpine on day 4.One hour after dosing of the 2nd article, behavioural observations werecarried out for vacuous chewing movements.

For the behavioral assessment, animals were individually placed in aplexiglass cage (13 cm×23 cm×13 cm). Mirrors were placed under the floorof the cage to permit observation of oral movements when the animalsfaced away from the observer. After a 5 min period of habituation, theoccurrence of vacuous chewing movements (VCM) was counted for a further10 min period. VCM were referred to as single mouth openings in thevertical plane not directed toward physical material. If VCM occurredduring a period of grooming, they were not taken into account.

The total number of VCM each group was recorded and the mean±SEM foreach group was determined. One-way ANOVA followed by Dunnett's test wasapplied for comparison between vehicle control and treated groups.Differences are considered significant at P <0.05(*).

The number of VCM's for the different test groups were (mean±SEM):

Vehicle (36.7±6.7);

Buspirone (3 mg/kg i.p.) plus zolmitriptan (30 mg/kg i.p.): (7.3±4.6)*.

In conclusion it was found that buspirone in combination withzolmitriptan significantly reduce reserpine induced tardive dyskinesiain mice.

Items

The following items additionally serve to describe the presentinvention:

-   -   1. A pharmaceutical composition comprising at least one        compound, wherein said compound is either an agonist of two or        more of the serotonin receptors selected from the group of        -   5-HT1B        -   5-HT1D        -   5-HT1F    -   receptors, or a selective agonist of the 5-HT1D receptor, or a        selective agonist of the 5-HT1F receptor, or a pharmaceutically        acceptable derivative thereof, and wherein said composition        further comprises a 5-HT1A agonist or a pharmaceutically        acceptable derivative thereof, for treatment, prevention or        alleviation of movement disorders.    -   2. The pharmaceutical composition according to item 1 wherein        the compound is an agonist of the 5-HT1B receptor and 5-HT1D        receptor or a pharmaceutically acceptable derivative thereof.    -   3. The pharmaceutical composition according to the previous        items, wherein the compound is a selective agonist of the 5-HT1D        receptor, or a selective agonist of the 5-HT1F receptor, or a        pharmaceutically acceptable derivative thereof.    -   4. The pharmaceutical composition according to the previous        items, wherein the compound is an agonist of the 5-HT1B        receptor, the 5-HT1D receptor and the 5-HT1F receptor, or a        pharmaceutically acceptable derivative thereof.    -   5. The pharmaceutical composition according to the previous        items wherein the compound has higher affinity and/or receptor        activation efficacy of the 5-HT1D receptor compared to the        5-HT1B receptor.    -   6. The pharmaceutical composition according to the previous        items wherein the compound has higher affinity and/or receptor        activation efficacy for the 5-HT1D receptor compared to the        5-HT1B and 5-HT1F receptors.    -   7. The pharmaceutical composition according to the previous        items wherein the compound is selected from the group of        sumatriptan, zolmitriptan, rizatriptan, naratriptan,        almotriptan, frovatriptan and eletriptan or pharmaceutically        acceptable derivatives thereof.    -   8. The pharmaceutical composition according to the previous        items wherein the compound is COL-144, LY334370, LY344864, or a        pharmaceutically acceptable derivative thereof.    -   9. The pharmaceutical composition according to the previous        items wherein the compound is administered in doses of 0.05-200        mg/day.    -   10. The pharmaceutical composition according to the previous        items wherein the compound is administered in doses of 0.5-60        mg/day, such as in doses of 0.5-10 mg/day.    -   11. The pharmaceutical composition according to the previous        items wherein the compound is administered in single doses of        0.05-100 mg/kg bodyweight.    -   12. The pharmaceutical composition according to the previous        items wherein the 5-HT1A agonist is selected from the group of        alnespirone, binospirone, buspirone, gepirone, ipsapirone,        perospirone, tandospirone, befiradol, repinotan piclozotan,        osemozotan, flesinoxan, flibanserin and sarizotan or a        pharmaceutically acceptable derivative thereof    -   13. The pharmaceutical composition according to the previous        items wherein the 5-HT1A agonist is tandospirone, gepirone or        buspirone or a pharmaceutically acceptable derivative thereof    -   14. The pharmaceutical composition according to the previous        items wherein compound is selected from the group of        zolmitriptan and frovatriptan or a pharmaceutically acceptable        derivative thereof, and the 5-HT1A receptor agonist is selected        from buspirone, tandospirone or gepirone or a pharmaceutically        acceptable derivative thereof    -   15. The pharmaceutical composition according to the previous        items wherein the compound is zolmitriptan or a pharmaceutically        acceptable derivative thereof and the 5-HT1A agonist is        buspirone or a pharmaceutically acceptable derivative thereof    -   16. The pharmaceutical composition according to previous items        wherein the 5-HT1A agonist is administered in doses of 0.05-500        mg/day.    -   17. The pharmaceutical composition according to the previous        items wherein the 5-HT1A agonist is administered in doses of        0.5-100 mg/day, such as in doses of 0.5-30 mg/day.    -   18. The pharmaceutical composition according to the previous        items wherein the 5-HT1A agonist is administered in doses of        0.5-100 mg/day and the compound is administered in doses of        0.5-60 mg/day, such as wherein the 5-HT1A agonist is        administered in doses of 0.5-30 mg/day and the compound is        administered in doses of 0.5-10 mg/day.    -   19. The pharmaceutical composition according to previous items        wherein the 5-HT1A agonist is administered in single doses of        0.05-100 mg/kg bodyweight.    -   20. The pharmaceutical composition according to the previous        items further comprising one or more second active ingredients.    -   21. The pharmaceutical composition according to the previous        items further comprising one or more second active ingredients        selected from the group of agents increasing the dopamine        concentration in the synaptic cleft, dopamine, L-DOPA or        dopamine receptor agonists or a pharmaceutically acceptable        derivative thereof.    -   22. The pharmaceutical composition according to the previous        items further comprising one or more second active ingredients        selected from the group of agents which ameliorate symptoms of        Parkinson's disease or which are used for treatment of        Parkinson's disease.    -   23. The pharmaceutical composition according to the previous        items wherein the compound is zolmitriptan or a pharmaceutically        acceptable derivative thereof and the 5-HT1A agonist is        buspirone or a pharmaceutically acceptable derivative thereof        further comprising L-DOPA or a pharmaceutically acceptable        derivative thereof    -   24. The pharmaceutical composition according to the previous        items further comprising two or more second active ingredients        wherein one is L-DOPA and the other is a carboxylase inhibitor,        such as carbidopa or benserazide.    -   25. The pharmaceutical composition according to item 24 wherein        the carboxylase inhibitor is carbidopa or benserazide.    -   26. The pharmaceutical composition according to the previous        items further comprising two or more second active ingredients        wherein one is L-DOPA and the other is a COMT inhibitor.    -   27. The pharmaceutical composition according to item 26 wherein        the COMT inhibitor is tolcapone, or entacapone.    -   28. The pharmaceutical composition according to the previous        items wherein the movement disorder is a movement disorder        associated with altered synaptic dopamine levels.    -   29. The pharmaceutical composition according to the previous        items wherein the movement disorder is one or more disorders        selected from group of tarditive dyskinesia, akathisia,        Parkinson's disease, movement disorders associated with        Parkinson's disease, such as bradykinesia, akinesia and        dyskinesia such as L-DOPA induced dyskinesia.    -   30. The pharmaceutical composition according to the previous        items wherein the movement disorder is one or more disorders        selected from the group of Parkinson's disease, movement        disorders associated with Parkinson's disease, such as akinesia,        and bradykinesia and dyskinesia such as L-DOPA induced        dyskinesia.    -   31. The pharmaceutical composition according to the previous        items wherein the movement disorder is dyskinesia associated        with Parkinson's disease, such as L-DOPA induced dyskinesia.    -   32. The pharmaceutical composition according to the previous        items wherein the movement disorder is tardive dyskinesia.    -   33. The pharmaceutical composition according to the previous        items formulated for parenteral administration.    -   34. The pharmaceutical composition according to the previous        items formulated for enteral administration such as oral        administration.    -   35. The pharmaceutical composition according to the previous        items formulated for crossing the blood-brain barrier.    -   36. A compound for treatment, prevention or alleviation of        movement disorders, wherein said compound is as defined in any        of the items 1 to 35.    -   37. A method for treatment, prevention or alleviation of        movement disorders comprising one or more steps of        administration of an effective amount of a pharmaceutical        composition or a compound as defined in any of the items 1 to 35        to an individual in need thereof.    -   38. The method according to item 37 wherein the compound as        defined in any of the items 1 to 35 is administered in doses of        0.05 mg/day to 200 mg/day.    -   39. The method according to items 37 to 38 wherein the compound        as defined in any of the items 1 to 35 is administered in doses        of 0.5 mg/day to 60 mg/day, such as in doses of 0.5 mg/day to 10        mg/day.    -   40. The method according to items 37 to 39 further comprising a        step of simultaneous, sequential or separate administration of a        effective amount of one or more second active ingredients.    -   41. The method according to items 37 to 39 wherein the compound        as defined in items 1 to 35 is administered simultaneously,        sequentially or separately in combination with an effective        amount of a 5-HT1A agonist.    -   42. The method according to items 37 to 41 wherein the compound        as defined in items 1 to 35 is administered simultaneously,        sequentially or separately in combination with an effective        amount of a 5-HT1A agonist selected from the group of        alnespirone, binospirone, buspirone, gepirone, ipsapirone,        perospirone, tandospirone, befiradol, repinotan, piclozotan,        osemozotan, flesinoxan, flibanserin and sarizotan or a        pharmaceutically acceptable derivative thereof.    -   43. The method according to items 40 to 42 wherein the 5-HT1A        agonist is selected from buspirone, gepirone or tandospirone or        a pharmaceutically acceptable derivative thereof.    -   44. The method according to items 40 to 43 wherein the 5-HT1A        agonist is administered in doses of 0.05 mg/day to 500 mg/day.    -   45. The method according to items 40 to 44 wherein the 5-HT1A        agonist is administered in doses of 0.5 mg/day to 100 mg/day,        such as in doses of 0.5 mg/day to 30 mg/day.    -   46. The method according to items 35 to 45, wherein the        pharmaceutical composition or compound as defined in items 1 to        35 is administered simultaneously, sequentially or separately in        combination with one or more second active ingredients selected        from the group of agents increasing the dopamine concentration        in the synaptic cleft, dopamine, L-DOPA or dopamine receptor        agonists or a pharmaceutically acceptable derivative thereof.    -   47. A kit of parts comprising the pharmaceutical composition or        compound as defined in items 1 to 35 for treatment, prevention        or alleviation of movement disorders.    -   48. The kit of parts according to item 47 further comprising one        or more second active ingredients for simultaneous, sequential        or separate administration.    -   49. The kit of parts according to items 47 to 48 further        comprising a 5-HT1A agonist.    -   50. The kit of parts according to item 49 further comprising a        5-HT1A agonist selected from the group of alnespirone,        binospirone, buspirone, gepirone, ipsapirone, perospirone,        tandospirone, befiradol, repinotan piclozotan, osemozotan,        flesinoxan, flibanserin and sarizotan or a pharmaceutically        acceptable derivative thereof.    -   51. The kit of parts according to items 49 to 50 wherein the        5-HT1A agonist is gepirone, tandospirone or buspirone or a        pharmaceutically acceptable derivative thereof.    -   52. The kit of parts according to items 48 to 51 further        comprising an agent increasing the dopamine concentration in the        synaptic cleft, dopamine, L-DOPA, dopamine receptor agonists or        a pharmaceutically acceptable derivative thereof.    -   53. A method for preparation of a pharmaceutical composition        according to items 1 to 35.

REFERENCES

-   Bonifati et al., Clin NeurPharmacol, 1994, 17, 73-82.-   Dekundy et al: Behavioural Brain Research 179 (2007) 76-89-   Del Sorbo and Albanese: J Neurol. 2008; 255 Suppl 4: 32-41.-   Elangbam et al: J Histochem Cytochem 53:671-677, 2005-   Filip et al. Pharmacol. Reports. (2009) 61, 761-777; Ohno, Central    Nervous System Agents in Medicinal Chemistry, 2010, 10, 148-157.-   Fox et al: Movement Disorders Vol. 24, No. 9, 2009.-   Grégoire et al: Parkinsonism Relat Disord. 2009; 15(6): 445-52.-   Jenner: Nat Rev Neurosci. 2008; 9(9): 665-77.-   Kirik et al.: J. Neurosci 2001; 21:2889-96-   Ludwig et al: Clin Neuropharmacol. 1986; 9(4):373-8-   Moss et al: J Clin Psychopharmacol. 1993 June; 13(3):204-9.-   Muñoz et al: Brain. 2008; 131(Pt 12): 3380-94-   Muñoz et al: Experimental Neurology 219 (2009) 298-307.-   Newman-Tancredi: Current Opinion in Investigational Drugs 2010    11(7):802-812.-   Olsson et al., J Neurosci; 15:3863-75, 1995-   Ohno, Central Nervous System Agents in Medicinal Chemistry, 2010,    10, 148-157-   Remington: The Science and Practice of Pharmacy, 20^(th) Edition,    Gennaro, Ed., Mack Publishing Co., Easton, Pa., 2000-   Roppongi et al: Prog Neuropsychopharmacol Biol Psychiatry. 2007;    31(1):308-10.-   Schallert et al., J. Neural Transpl Plast 1992; 3:332-3

1. A pharmaceutical composition comprising at least one compound,wherein said compound is either an agonist of two or more of theserotonin receptors selected from the group of 5-HT1B 5-HT1D 5-HT1Freceptors, or a selective agonist of the 5-HT1D receptor, or a selectiveagonist of the 5-HT1F receptor, or a pharmaceutically acceptablederivative thereof, and wherein said composition further comprises a5-HT1A agonist or a pharmaceutically acceptable derivative thereof, fortreatment, prevention or alleviation of movement disorders.
 2. Thepharmaceutical composition according to claim 1 wherein the compound isan agonist of the 5-HT1B receptor and 5-HT1D receptor or apharmaceutically acceptable derivative thereof.
 3. The pharmaceuticalcomposition according to the previous claims, wherein the compound is aselective agonist of the 5-HT1D receptor, or a selective agonist of the5-HT1F receptor, or a pharmaceutically acceptable derivative thereof. 4.The pharmaceutical composition according to the previous claims, whereinthe compound is an agonist of the 5-HT1B receptor, the 5-HT1D receptorand the 5-HT1F receptor, or a pharmaceutically acceptable derivativethereof.
 5. The pharmaceutical composition according to the previousclaims wherein the compound has higher affinity and/or receptoractivation efficacy of the 5-HT1D receptor compared to the 5-HT1Breceptor.
 6. The pharmaceutical composition according to the previousclaims wherein the compound has higher affinity and/or receptoractivation efficacy for the 5-HT1D receptor compared to the 5-HT1B and5-HT1F receptors.
 7. The pharmaceutical composition according to theprevious claims wherein the compound is selected from the group ofsumatriptan, zolmitriptan, rizatriptan, naratriptan, almotriptan,frovatriptan and eletriptan or pharmaceutically acceptable derivativesthereof.
 8. The pharmaceutical composition according to the previousclaims wherein the compound is COL-144, LY334370, LY344864, or apharmaceutically acceptable derivative thereof.
 9. The pharmaceuticalcomposition according to the previous claims wherein the compound isadministered in doses of 0.05-200 mg/day.
 10. The pharmaceuticalcomposition according to the previous claims wherein the compound isadministered in doses of 0.5-60 mg/day, such as in doses of 0.5-10mg/day.
 11. The pharmaceutical composition according to the previousclaims wherein the compound is administered in single doses of 0.05-100mg/kg bodyweight.
 12. The pharmaceutical composition according to theprevious claims wherein the 5-HT1A agonist is selected from the group ofalnespirone, binospirone, buspirone, gepirone, ipsapirone, perospirone,tandospirone, befiradol, repinotan piclozotan, osemozotan, flesinoxan,flibanserin and sarizotan or a pharmaceutically acceptable derivativethereof.
 13. The pharmaceutical composition according to the previousclaims wherein the 5-HT1A agonist is tandospirone, gepirone or buspironeor a pharmaceutically acceptable derivative thereof.
 14. Thepharmaceutical composition according to the previous claims whereincompound is selected from the group of zolmitriptan and frovatriptan ora pharmaceutically acceptable derivative thereof, and the 5-HT1Areceptor agonist is selected from buspirone, tandospirone or gepirone ora pharmaceutically acceptable derivative thereof.
 15. The pharmaceuticalcomposition according to the previous claims wherein the compound iszolmitriptan or a pharmaceutically acceptable derivative thereof and the5-HT1A agonist is buspirone or a pharmaceutically acceptable derivativethereof.
 16. The pharmaceutical composition according to previous claimswherein the 5-HT1A agonist is administered in doses of 0.05-500 mg/day.17. The pharmaceutical composition according to the previous claimswherein the 5-HT1A agonist is administered in doses of 0.5-100 mg/day,such as in doses of 0.5-30 mg/day.
 18. The pharmaceutical compositionaccording to the previous claims wherein the 5-HT1A agonist isadministered in doses of 0.5-100 mg/day and the compound is administeredin doses of 0.5-60 mg/day, such as wherein the 5-HT1A agonist isadministered in doses of 0.5-30 mg/day and the compound is administeredin doses of 0.5-10 mg/day.
 19. The pharmaceutical composition accordingto previous claims wherein the 5-HT1A agonist is administered in singledoses of 0.05-100 mg/kg bodyweight.
 20. The pharmaceutical compositionaccording to the previous claims further comprising one or more secondactive ingredients.
 21. The pharmaceutical composition according to theprevious claims further comprising one or more second active ingredientsselected from the group of agents increasing the dopamine concentrationin the synaptic cleft, dopamine, L-DOPA or dopamine receptor agonists ora pharmaceutically acceptable derivative thereof.
 22. The pharmaceuticalcomposition according to the previous claims further comprising one ormore second active ingredients selected from the group of agents whichameliorate symptoms of Parkinson's disease or which are used fortreatment of Parkinson's disease.
 23. The pharmaceutical compositionaccording to the previous claims wherein the compound is zolmitriptan ora pharmaceutically acceptable derivative thereof and the 5-HT1A agonistis buspirone or a pharmaceutically acceptable derivative thereof furthercomprising L-DOPA or a pharmaceutically acceptable derivative thereof.24. The pharmaceutical composition according to the previous claimsfurther comprising two or more second active ingredients wherein one isL-DOPA and the other is a carboxylase inhibitor, such as carbidopa orbenserazide.
 25. The pharmaceutical composition according to claim 24wherein the carboxylase inhibitor is carbidopa or benserazide.
 26. Thepharmaceutical composition according to the previous claims furthercomprising two or more second active ingredients wherein one is L-DOPAand the other is a COMT inhibitor.
 27. The pharmaceutical compositionaccording to claim 26 wherein the COMT inhibitor is tolcapone, orentacapone.
 28. The pharmaceutical composition according to the previousclaims wherein the movement disorder is a movement disorder associatedwith altered synaptic dopamine levels.
 29. The pharmaceuticalcomposition according to the previous claims wherein the movementdisorder is one or more disorders selected from group of tarditivedyskinesia, akathisia, Parkinson's disease, movement disordersassociated with Parkinson's disease, such as bradykinesia, akinesia anddyskinesia such as L-DOPA induced dyskinesia.
 30. The pharmaceuticalcomposition according to the previous claims wherein the movementdisorder is one or more disorders selected from the group of Parkinson'sdisease, movement disorders associated with Parkinson's disease, such asakinesia, and bradykinesia and dyskinesia such as L-DOPA induceddyskinesia.
 31. The pharmaceutical composition according to the previousclaims wherein the movement disorder is dyskinesia associated withParkinson's disease, such as L-DOPA induced dyskinesia.
 32. Thepharmaceutical composition according to the previous claims wherein themovement disorder is tardive dyskinesia.
 33. The pharmaceuticalcomposition according to the previous claims formulated for parenteraladministration.
 34. The pharmaceutical composition according to theprevious claims formulated for enteral administration such as oraladministration.
 35. The pharmaceutical composition according to theprevious claims formulated for crossing the blood-brain barrier.
 36. Acompound for treatment, prevention or alleviation of movement disorders,wherein said compound is as defined in any of the claims 1 to
 35. 37. Amethod for treatment, prevention or alleviation of movement disorderscomprising one or more steps of administration of an effective amount ofa pharmaceutical composition or a compound as defined in any of theclaims 1 to 35 to an individual in need thereof.
 38. The methodaccording to claim 37 wherein the compound as defined in any of theclaims 1 to 35 is administered in doses of 0.05 mg/day to 200 mg/day.39. The method according to claims 37 to 38 wherein the compound asdefined in any of the claims 1 to 35 is administered in doses of 0.5mg/day to 60 mg/day, such as in doses of 0.5 mg/day to 10 mg/day. 40.The method according to claims 37 to 39 further comprising a step ofsimultaneous, sequential or separate administration of a effectiveamount of one or more second active ingredients.
 41. The methodaccording to claims 37 to 39 wherein the compound as defined in claims 1to 35 is administered simultaneously, sequentially or separately incombination with an effective amount of a 5-HT1A agonist.
 42. The methodaccording to claims 37 to 41 wherein the compound as defined in claims 1to 35 is administered simultaneously, sequentially or separately incombination with an effective amount of a 5-HT1A agonist selected fromthe group of alnespirone, binospirone, buspirone, gepirone, ipsapirone,perospirone, tandospirone, befiradol, repinotan, piclozotan, osemozotan,flesinoxan, flibanserin and sarizotan or a pharmaceutically acceptablederivative thereof.
 43. The method according to claims 40 to 42 whereinthe 5-HT1A agonist is selected from buspirone, gepirone or tandospironeor a pharmaceutically acceptable derivative thereof.
 44. The methodaccording to claims 40 to 43 wherein the 5-HT1A agonist is administeredin doses of 0.05 mg/day to 500 mg/day.
 45. The method according toclaims 40 to 44 wherein the 5-HT1A agonist is administered in doses of0.5 mg/day to 100 mg/day, such as in doses of 0.5 mg/day to 30 mg/day.46. The method according to claims 35 to 45, wherein the pharmaceuticalcomposition or compound as defined in claims 1 to 35 is administeredsimultaneously, sequentially or separately in combination with one ormore second active ingredients selected from the group of agentsincreasing the dopamine concentration in the synaptic cleft, dopamine,L-DOPA or dopamine receptor agonists or a pharmaceutically acceptablederivative thereof.
 47. A kit of parts comprising the pharmaceuticalcomposition or compound as defined in claims 1 to 35 for treatment,prevention or alleviation of movement disorders.
 48. The kit of partsaccording to claim 47 further comprising one or more second activeingredients for simultaneous, sequential or separate administration. 49.The kit of parts according to claims 47 to 48 further comprising a5-HT1A agonist.
 50. The kit of parts according to claim 49 furthercomprising a 5-HT1A agonist selected from the group of alnespirone,binospirone, buspirone, gepirone, ipsapirone, perospirone, tandospirone,befiradol, repinotan piclozotan, osemozotan, flesinoxan, flibanserin andsarizotan or a pharmaceutically acceptable derivative thereof.
 51. Thekit of parts according to claims 49 to 50 wherein the 5-HT1A agonist isgepirone, tandospirone or buspirone or a pharmaceutically acceptablederivative thereof.
 52. The kit of parts according to claims 48 to 51further comprising an agent increasing the dopamine concentration in thesynaptic cleft, dopamine, L-DOPA, dopamine receptor agonists or apharmaceutically acceptable derivative thereof.
 53. A method forpreparation of a pharmaceutical composition according to claims 1 to 35.